Masculinizing hormone therapy
The goal of the therapy, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their gender identity.
These medical uses of masculinizing hormone therapy are subject to individual health considerations and are typically administered under the supervision of healthcare professionals.
[citation needed] Relative medical contraindications are: Due to insufficient comprehensive research, there is no consensus on the long-term effects of testosterone administration.
[6] The other study found elevated risk of heart attacks among self-identified transgender men—which persisted even after adjusting for age, diabetes mellitus, chronic kidney disease, smoking, hypertension, hypercholesterolemia, and exercise—though the study did not include data about whether the subjects were undergoing hormone therapy and did not control for stressors.
A 2022 review entitled The efficacy, safety, and outcomes of testosterone use among transgender men patients: A review of the literature,[9] while pointing out that more research is needed for newer therapies, concludes that: More conventional therapies, including intramuscular injections, subcutaneous injections, and transdermal gels, have been extensively studied and show promising efficacy and outcomes with limited safety concerns.Testosterone is metabolized by the cytochrome P450 enzyme system (specifically CYP3A isoforms) in the liver.
There are certain drugs that increase or decrease the activity of cytochrome P450 enzymes and may cause increased or decreased levels of testosterone: Testosterone can also alter the effects of other drugs: Because of these interactions, it is advised that trans men make their healthcare providers aware of their hormone therapy when this is relevant to their treatment for other medical issues.
Injectable forms of testosterone can cause a lung problem called pulmonary oil microembolism (POME).
Symptoms of POME include cough, shortness of breath, tightening of the throat, chest pain, sweating, dizziness, and fainting.
Transdermal testosterone has the advantage of delivering a consistent supply of hormones over a given period and having a simple method of diffusion.
[27] Transdermal testosterone is available throughout the world under the brand names Andromen Forte, Androgel, Testogel and Testim.
They are absorbed quickly when applied and produce a temporary drug depot in the skin which diffuses into the circulation, peaking at 4 hours and decreasing slowly over the rest of the day.
This is most important for patients whose intimate partners are pregnant or those who are parents of young children as both of these groups are more vulnerable to the masculinizing effects of androgens.
Case reports of significant virilization of young children after exposure to topical androgen preparations (both prescription and 'supplement' products) used by their caregivers demonstrates this very real risk, the same principle also applies to estrogens.
The primary advantages of Testopel are that it gives a much more constant blood level of testosterone yet requires attention only four times yearly.
In addition, the first-pass metabolism of the liver also may result in testosterone levels too low to provide satisfactory masculinization and suppress menses.
The lozenges can cause gum irritation, taste changes, and headache but most side effects diminish after two weeks.
AAS that are 17α-alkylated like methyltestosterone, oxandrolone, and stanozolol are orally active but carry a high risk of liver damage, whereas AAS that are not 17α-alkylated, like nandrolone esters, must be administered by intramuscular injection (via which they act as long-lasting depots similarly to testosterone esters) but have no more risk of liver damage than does testosterone.
These drugs all share the same core mechanism of action of acting as agonists of the AR and have similar effects, although their potency, pharmacokinetics, oral activity, ratio of anabolic to androgenic effects (due to differing capacities to be locally metabolized and potentiated by 5α-reductase), capacity for aromatization (i.e., conversion into an estrogen), and potential for liver damage may all differ.
[29] DHT is available in formulations including topical gel, buccal or sublingual tablets, and as esters in oil for intramuscular injection.
In those who have not yet started or completed epiphyseal closure, growth hormone can be administered, potentially in conjunction with an aromatase inhibitor or a GnRH analogue, to increase final height.
The main effects of testosterone in trans men are as follows:[35] Facial changes develop gradually over time, and sexual dimorphism (physical difference between the sexes) tends to increase with age.
Within a population of similar body size and ethnicity: Frequently the first sign of endometrial cancer is bleeding in post-menopausal women.
[43] Many transgender men, however, report improved mood, decreased emotional lability, and a lessening of anger and aggression.
[44] During HRT, especially in the early stages of treatment, blood tests should be consistently done to assess hormone levels and liver function.
In post-oophorectomy trans men, Israel and colleagues recommend that both testosterone and estrogen levels fall exactly within the normal male ranges.
