From the Guidelines
For female to male transition, a testosterone level of 797 ng/dL is within the target range for masculinization, and the goal is to maintain testosterone levels comparable to cisgender males, typically between 300-1,000 ng/dL, as recommended by the most recent study on hormone treatment for transgender men 1. The goal of testosterone therapy in gender-affirming care for transgender men is to achieve testosterone levels comparable to cisgender males, which is optimal for developing and maintaining masculine secondary sex characteristics.
- Common testosterone formulations include intramuscular injections (testosterone cypionate or enanthate), transdermal gels, or subcutaneous pellets, with the choice of formulation depending on individual patient needs and preferences 1.
- Regular monitoring of testosterone levels is important, with testing typically done at trough levels (just before the next dose for injections) to ensure levels remain therapeutic without becoming excessive.
- Side effects to monitor include polycythemia (elevated red blood cell count), acne, hair loss, and mood changes, as well as potential risks to bone health, fertility, and cardiovascular health 1.
- Liver function, lipid profiles, and hematocrit should be checked periodically to minimize the risks associated with testosterone therapy.
- It is also important to note that testosterone therapy can lower voice pitch, change body composition, and increase libido, and that trans men undergoing gender-affirming treatment should be aware of the potential risks and benefits of hormone therapy 1.
From the Research
Testosterone Levels for Female-to-Male Transition
- The normal range for total testosterone in female-to-male transition is typically considered to be within the male range, which is around 250-1100 ng/dL 2, 3.
- Studies have shown that testosterone replacement therapy (TRT) can effectively increase total testosterone levels in female-to-male transgender patients, with most patients achieving levels within the normal male range 2, 3, 4.
- The dose of testosterone required to achieve these levels can vary, but typical doses range from 50-150 mg per week for subcutaneous injections 2 and 125-250 mg every 2-3 weeks for intramuscular injections 4.
Administration Methods
- Subcutaneous injections of testosterone have been shown to be an effective and well-tolerated alternative to intramuscular injections, with fewer local reactions and a preference for subcutaneous injections among patients 2, 3.
- A study comparing intramuscular testosterone cypionate to subcutaneous testosterone enanthate found that both methods effectively increased total testosterone levels, but subcutaneous injections were associated with lower levels of estradiol and hematocrit 5.
Monitoring and Safety
- Regular monitoring of total testosterone, free testosterone, and luteinizing hormone (LH) levels is important to ensure correct androgenization and minimize risks associated with long-term testosterone administration 6.
- Strict monitoring of lipid profile, evaluation of body mass index (BMI) and hematocrit, and avoidance of self-initiated therapeutic modifications can help limit risks linked to long-term testosterone administration 6.