From the Guidelines
Testosterone therapy is the primary method used to induce amenorrhea in transgender men. This approach involves administering testosterone to achieve serum testosterone concentrations within the typical cisgender male reference range 1. The goal of testosterone therapy is to produce virilization, which includes menstrual suppression, and can be achieved through various regimens such as gels, patches, injectable esters, and testosterone undecanoate 1.
- Testosterone regimens: Injectable esters, such as testosterone cypionate or enanthate, are commonly administered subcutaneously to achieve the desired testosterone levels 1.
- Dosage and administration: The dosage and administration of testosterone therapy may vary depending on the individual patient's needs and response to treatment 1.
- Monitoring and adjustment: Regular monitoring of patients is essential to adjust the treatment regimen as needed and minimize potential side effects, such as polycythaemia, reduced high-density lipoprotein cholesterol, androgenic alopecia, acne, and gynaecological effects 1.
- Additional considerations: Transgender men undergoing gender-affirming treatment should be aware of the risks associated with hypogonadism, fertility, and pregnancy, as well as the potential risks of erythrocytosis and cardiovascular outcomes 1.
From the Research
Methods for Inducing Amenorrhea in Transgender Men
The use of testosterone therapy is a common method for inducing amenorrhea in transgender men. According to 2, the initiation of low to moderate testosterone therapy can lead to menstrual cessation in the majority of patients by 6 months and nearly all by 1 year. The dose of testosterone correlated only loosely with the time of cessation.
Testosterone Therapy
Testosterone therapy is a cornerstone of medical treatment for transgender men, with the goal of achieving serum testosterone concentrations in the male reference range 3. The desired effects of testosterone therapy include cessation of menstruation, as well as increased facial and body hair, deepening of the voice, and increased sexual desire. Testosterone can be administered via topical or injectable preparations to achieve physical changes resulting in masculinisation and improve quality of life for the treated individuals 4.
Other Methods for Menstrual Suppression
In addition to testosterone therapy, other methods for menstrual suppression can be used, including:
- Depot-medroxyprogesterone acetate
- Levonorgestrel intrauterine systems
- Progestin-only contraceptive pills
- Combined hormonal contraceptives
- Norethindrone acetate
- Oral medroxyprogesterone acetate
- Gonadotropin-releasing hormone analogues/agonists
- Danazol 5
Individual Variability
There is individual variability in the time to cessation of menstruation with testosterone therapy, with little correlation to testosterone dose 2. Some patients may also benefit from non-pharmacologic interventions, such as specialty menstrual underwear 5.
Key Findings
Key findings from the studies include:
- Testosterone therapy is a safe and effective method for inducing amenorrhea in transgender men 2, 3, 4
- The dose of testosterone correlated only loosely with the time of cessation of menstruation 2
- Other methods for menstrual suppression can be used in addition to testosterone therapy 5
- Individual variability in the time to cessation of menstruation with testosterone therapy exists, with little correlation to testosterone dose 2