Effects of Three Different Testosterone Formulations in Female-to-Male Transsexual Persons

Abstract

Introduction Gender dysphoria is characterized by a strong discomfort with the gender assigned at birth and the urge to live as a member of the opposite gender. The acquisition of phenotypic features of the desired gender requires the use of cross-sex hormones. Female-to-male (FtM) transsexual persons are treated with testosterone to induce virilization. Aim The aim of the study was to assess the effects of three different testosterone formulations on body weight and composition and metabolic and bone parameters. Methods Forty-five FtM transsexuals were randomly assigned to receive testoviron depot (i.m.: 100 mg/10 days; n = 15), testosterone gel (50 mg/die; n = 15), and testosterone undecanoate (i.m.: 1,000 mg every 6 weeks for the first 6 weeks and then every 12 weeks, n = 15). FtM individuals were studied before, at week 30, and at week 54 of testosterone treatment. Main Outcome Measures Anthropometric, metabolic, bone, hematological, and biochemical parameters were evaluated at baseline and after 12 months of treatment. Results Lean body mass significantly increased and fat mass decreased in all groups. No modifications were reported in fasting insulin and insulin sensitivity index. High-density plasma lipoprotein levels declined significantly and low-density lipoprotein concentrations increased significantly in the three groups. The activated partial thromboplastin time and factor I did not change while prothrombin time significantly increased in all groups. At week 54, all subjects were amenorrheic and time to amenorrhea did not differ between the three groups. Current general life satisfaction was increased in all subjects after 1 year of treatment. Conclusions One-year testosterone administration in FtM transsexuals appears to be very safe with no differences among the testosterone formulations used. Our study is preliminary, and the detection of subtle or long-term differences in the effects of the three formulations may require further larger and longer term studies in this and other populations.

Metabolic Effects Of Hormone Therapy In Transgender Patients

“…Several studies note an increase in BMI for FtM patients after initiation of hormone therapy [9], [12], [13], [14]. Similarly, our study also saw an increase in BMI at Visit 1 in the FtM cohort, possibly due to increased muscle mass.…”

“…Additionally, the FtM cohort showed an increase in creatinine at both Visit 1 and Visit 2; this would be an expected change if the FtM cohort had an average increase in muscle mass and thus muscle break-down products – a possibility given the observed increase in BMI. Testosterone use in hormone therapy for transgender men is associated with an increase in hemoglobin and hematocrit [11], [12], [13] [14], [15]. Our study also observed an increase in the hemogram parameters for the FtM cohort at Visit 1 and Visit 2.…”

Priorities for transgender medical and healthcare research

“…Similar studies of testosterone therapy in transgender men report decreases in HDL cholesterol, increases in triglycerides and either no change or increase in LDL cholesterol [30,31,33,34]. Cross-sectional studies, retrospective cohort studies, and a systematic literature review all have similar findings [21,26,32,35].…”

“…Small prospective studies exist which examine time to menstrual cessation with testosterone therapy [31,33]. Outcomes research on other transition related interventions, including speech therapy, are scattered throughout the literature [51,52,53].…”

Quantitative imaging techniques for the assessment of osteoporosis and sarcopenia

“…The role of DXA is central in the study of body composition (BC) thanks to its ability to differentiate FM, non-bone lean mass (LM) and BMC at both the regional and the whole-body level ( Figure 2) (49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60). DXA relies on the use of two X-ray beams of different energy; the measurement of the "R value" is calculated as the ratio between the degree of attenuation of the lower energy and the higher energy beam.…”