Recommendations for the Use of Testosterone in Male Transgender

Abstract

Gender incongruence is defined as a condition in which an individual self-identifies and desires to have physical characteristics and social roles that connote the opposite biological sex. Gender dysphoria is when an individual displays the anxiety and/or depression disorders that result from the incongruity between the gender identity and the biological sex. The gender affirmation process must be performed by a multidisciplinary team. The main goal of the hormone treatment is to start the development of male physical characteristics by means of testosterone administration that may be offered to transgender men who are 18 years old or over. The use of testosterone is usually well tolerated and improves the quality of life. However, there is still lack of evidence regarding the effects and risks of the long-term use of this hormone. Many different pharmacological formulations have been used in the transsexualization process. The most commonly used formulation is the intramuscular testosterone esters in a short-term release injection, followed by testosterone cypionate or testosterone enanthate. In the majority of testosterone therapy protocols, the male physical characteristics can be seen in almost all users after 6 months of therapy, and the maximum virilization effects are usually achieved after 3 to 5 years of regular use of the hormone. To minimize risks, plasmatic testosterone levels should be kept within male physiological ranges (300 to 1,000 ng/dl) during hormonal treatment. It is recommended that transgender men under androgen therapy be monitored every 3 months during the 1st year of treatment and then, every 6 to 12 months.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…If required and if possible, assessment for GAMST should be conducted by a multidisciplinary team (Costa, Rosa-e-Silva et al., 2018 ; Hembree et al., 2017 ; Karasic & Fraser, 2018 ; T'Sjoen et al., 2020) with team members who have timely and adequate contact with one another. This could include an MHP, an endocrinologist, a primary care provider, a surgeon, a voice and communication specialist, TGD peer navigator, and others.…”

Liver function in transgender persons: Challenges in the COVID-19 era

“…Nonetheless, hepatotoxicity due to the long-term administration of exogenous testosterone esters is always a concern during therapy of transgender males. For this reason, trans men under androgen therapy should be monitored every three months during the first year of treatment and then semi-annually or annually[ 25 ]. Aspartate and alanine aminotransferases (AST and ALT, respectively) are the most commonly used biomarkers of liver injury.…”

Navigating Human Immunodeficiency Virus and Primary Care Concerns Specific to the Transgender and Gender-Nonbinary Population

“…Starting doses of subcutaneous or intramuscular testosterone cypionate or enanthate range from 20 to 50 mg weekly, titrated up until desired effects are obtained [ 41 ]. Some guidelines suggest a maximum dose of 200 mg every 2 weeks to minimize adverse cardiovascular and psychological effects [ 42 , 43 ]. Recent studies show that subcutaneous testosterone is associated with less injection site pain compared to intramuscular injections with some added benefits, including less variability in serum concentrations ( Table 3 ) [ 44 , 45 ].…”