From the Guidelines
The recommended hormone regimen for Trans men typically involves testosterone therapy, with the goal of achieving serum testosterone concentrations in the typical cisgender male reference range of 300-1,000 ng/dL. The standard approach involves either intramuscular testosterone cypionate or enanthate injections, transdermal testosterone gel, testosterone patches, or subcutaneous pellet implants, with dose adjustments based on blood levels and clinical response 1.
Key Considerations
- Treatment begins with lower doses that gradually increase over several months to allow for monitored masculinization.
- Regular monitoring includes checking testosterone levels, complete blood count, lipid profiles, and liver function tests every 3 months initially, then annually once stable 1.
- Patients should expect gradual changes including deepened voice, increased muscle mass, facial/body hair growth, cessation of menses, and fat redistribution.
- Some effects like voice changes are permanent, while others require ongoing therapy to maintain.
Potential Side Effects
- Acne
- Male pattern baldness
- Mood changes
- Increased red blood cell count
- Polycythaemia
- Reduced high density lipoprotein cholesterol (HDL-c)
- Androgenic alopecia
- Gynaecological effects such as pelvic pain and genital dryness
- Potentially increased risk of myocardial infarction 1
Important Notes
- Changes such as lowered voice pitch and hair changes are irreversible even if testosterone therapy is ceased 1.
- Immune function appears to mirror that of cisgender men on testosterone therapy 1.
- Trans men undergoing gender-affirming treatment should be aware of the risk to bone health, associated with hypogonadism, risk to fertility and pregnancy, and risk of erythrocytosis 1.
From the FDA Drug Label
Prior to initiating Testosterone Gel, 1. 62%, confirm the diagnosis of hypogonadism by ensuring that serum testosterone concentrations have been measured in the morning on at least two separate days and that these serum testosterone concentrations are below the normal range.
The recommended hormone regimen for Trans men is not explicitly stated in the provided drug labels. However, the labels do provide information on the diagnosis and treatment of hypogonadism in males, which may be relevant to Trans men undergoing hormone therapy.
- Key points to consider when initiating hormone therapy for Trans men include:
- Confirming the diagnosis of hypogonadism through serum testosterone concentration measurements
- Starting with a recommended dose of 40.5 mg of testosterone (2 pump actuations) applied topically once daily in the morning
- Adjusting the dose based on pre-dose morning serum testosterone concentration at approximately 14 days and 28 days after starting treatment or following dose adjustment
- Assessing serum testosterone concentration periodically thereafter 2, 2, 2
From the Research
Hormone Regimen for Trans Men
The recommended hormone regimen for Trans men typically involves testosterone therapy, which is a cornerstone of medical treatment for transgender men who choose to undergo it 3. The goal of testosterone therapy is usually to achieve serum testosterone concentrations in the male reference range.
Desired Effects of Testosterone Therapy
The desired effects of testosterone therapy include:
- Increased facial and body hair
- Increased lean mass and strength
- Decreased fat mass
- Deepening of the voice
- Increased sexual desire
- Cessation of menstruation
- Clitoral enlargement
- Reductions in gender dysphoria, perceived stress, anxiety, and depression 3
Testosterone Formulations and Administration
Different pharmacological formulations have been used in the transsexualization process, with intramuscular testosterone esters in a short-term release injection being the most commonly used formulation, followed by testosterone cypionate or testosterone enanthate 4. Testosterone gel and intramuscular injections are also frequently used and are registered and included in international guidelines 5.
Monitoring and Dosage
To minimize risks, plasmatic testosterone levels should be kept within male physiological ranges (300 to 1,000 ng/dl) during hormonal treatment 4. 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 4. Low-dose testosterone administration (≤ 62.5 mg/wk) can be sufficient to increase lean body mass in trans men, while higher doses (> 62.5 mg/wk) can lead to an earlier increase in muscle mass 6.
Menstrual Cessation
The initiation of low to moderate testosterone (20-40 mg weekly) is sufficient in leading to menstrual cessation in the majority of patients by 6 months and nearly all by 1 year, with individual variability in the time to cessation and little correlation to testosterone dose 7.
Safety and Efficacy
Long-term gender-affirming hormone therapy (GAHT) for trans men is safe and effective, with no long-term, dose-dependent side effects such as polycythemia or dyslipidemia 6. However, there is still a lack of evidence regarding the effects and risks of the long-term use of testosterone 4.