From the Guidelines
The target testosterone level for a transgender man undergoing testosterone therapy should be within the typical physiological range for cisgender men, which is 300–1,000 ng/dL. This range is recommended to achieve virilization and minimize potential side effects 1. The goal of hormone therapy is to bring testosterone levels into this range, which can be achieved through various regimens, including gels, patches, injectable esters, and testosterone undecanoate 1.
Some key points to consider when targeting this range include:
- Testosterone therapy can produce desired effects such as lowering voice pitch, changing body composition, and increasing libido 1
- Regular monitoring of testosterone levels is necessary, with blood tests conducted every 3 months during the first year of therapy, then 1-2 times yearly thereafter [based on general clinical practice]
- Dosage adjustments may be necessary based on individual response, and regular monitoring of complete blood count, lipid profile, and liver function tests is recommended alongside testosterone levels 1
- Trans men undergoing gender-affirming treatment should be aware of potential risks, including those to bone health, fertility, and pregnancy, as well as the risk of erythrocytosis 1
It is essential to note that the evidence suggests that testosterone therapy can be safe and effective when properly monitored and managed 1. However, individual responses may vary, and regular follow-up with a healthcare provider is crucial to ensure the best possible outcomes.
From the FDA Drug Label
The recommended starting dose of testosterone gel, 1.62% is 40. 5 mg of testosterone (2 pump actuations) applied topically once daily in the morning to the shoulders and upper arms. The dose can be adjusted between a minimum of 20. 25 mg of testosterone (1 pump actuation) and a maximum of 81 mg of testosterone (4 pump actuations). To ensure proper dosing, the dose should be titrated based on the pre-dose morning serum testosterone concentration from a single blood draw at approximately 14 days and 28 days after starting treatment or following dose adjustment In addition, serum testosterone concentration should be assessed periodically thereafter. Table 1 describes the dose adjustments required at each titration step. Table 1: Dose Adjustment Criteria Pre-Dose Morning Total Serum Testosterone Concentration Dose Titration Greater than 750 ng/dL Decrease daily dose by 20. 25 mg (1 pump actuation) Equal to or greater than 350 and equal to or less than 750 ng/dL No change: continue on current dose Less than 350 ng/dL Increase daily dose by 20.25 mg (1 pump actuation)
The target testosterone level for a patient undergoing testosterone therapy is between 350 ng/dL and 750 ng/dL 2.
From the Research
Target Testosterone Level for Transgender Men
The target testosterone level for transgender men undergoing testosterone therapy is typically within the male physiological range.
- The normal male physiological range is between 300 to 1,000 ng/dl 3, 4
- This range is considered the target for hormone therapy to achieve masculinization in transgender men 3, 4, 5
- Testosterone levels within this range are associated with the development of male physical characteristics, such as increased facial and body hair, deepening of the voice, and increased lean mass and strength 6, 3, 5
Monitoring Testosterone Levels
Regular monitoring of testosterone levels is recommended to ensure that they remain within the target range.
- Transgender men under androgen therapy should be monitored every 3 months during the first year of treatment and then every 6 to 12 months 3, 4
- Monitoring should include measurements of serum testosterone levels, as well as other health parameters such as hemoglobin, cholesterol, and fasting glucose 7
Achieving Target Testosterone Levels
Achieving testosterone levels within the target range is considered a prerequisite for the safety of gender-affirming treatment.
- A study found that transgender men who achieved a serum testosterone level within the normal range of cisgender male counterparts had a mean testosterone serum level of approximately 545 ng/dL 5
- Treatment with testosterone is routinely used for the promotion of virilizing physical changes in transgender men, but the likelihood of adverse effects of continuous treatment is still unclear 5, 7