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It is unlikely that you would need to completely stop testosterone just because you are experiencing depressive symptoms on one specific type of testosterone. A Guide to Microdosing Testosterone During Your Transition - VICE Effects of masculinizing hormone therapy. doi:10.1177/1756287215612961, Kumar P, Kumar N, Thakur DS, Patidar A. We provide this information in order to bring options to the attention of transgender patients and to empower them to have informed conversations with their doctors. Available measures to reduce associated risks should be considered and discussed with patients and if possible, undertaken prior to or concurrently with the initiation of hormone therapy. Specifically, the aim of this kind of treatment is the development of male secondary sex characteristics through clinical response. 2016;11(9):e0162480. Masculinizing Hormone Therapy: Testosterone, Side Effects, Timeline Transgender men and other transmasculine people may use testosterone to masculinize their bodies in order to align their bodies with their gender identity. Metzger NY, Boettger S. The effect of testosterone therapy on personality traits of trans men: a controlled prospective study in Germany and Switzerland. You may opt-out of email communications at any time by clicking on They are likely not selling you a pure product and are not concerned about your wellbeing. For more information, please see our By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. It should not be given intravenously. 1999;11(2):137-43. Your doctor may adjust your dose as needed. Clin Endocrinol (Oxf). Last updated on Mar 1, 2023. doi:10.4103/0110-5558.72420. When you stop treatment, some things might go back to how they were before, but others, such as the deepening of the voice, will not change. Planned Parenthood. There is a problem with There are no studies to guide the interpretation of BMD results and fracture risk in trans people, and whether to use sex assigned at birth or affirmed gender. Make sure that you wash your hands with soap and water before and after applying the gel. Standard starting dose is .25ml (200mg/ml) per week, and the standard dose once it's increased is .5ml (200mg/ml) per week. This is the most widely used form of cross-sex hormone therapy for FTM transitions. If the patient has no experience with penetration, it may be helpful to know this in advance and to suggest that they try penetration at home first using a small toy, fingers or a speculum. A full dose is considered 100 mg per week. Results of long termtestosteronereplacement therapy in men with abdominal obesity, erectile dysfunction andtestosteronedeficiency. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. However, the dose is usually not more than 100 mg per day. 2015;14:18. Collection of the BD SurePath Pap Test with a broom device plus endocervical brush improves disease detection when compared to the broom device alone or the spatula plus endocervical brush combination. include protected health information. If you take testosterone injections, you can expect that your menstrual periods will stop, your hips will narrow, your shoulders will broaden and your neck, fingers and feet will thicken 3. Something went wrong while submitting the form. This can cause both personal and professional difficulties, but for singers, the "unpredictable and irreversible" 1 nature of testosterone's effects on the voice is a terrifying prospect. Am J Physiol Endocrinol Metab. J Clin Endocrinol Metab. The suggested dosage for DEPO-Testosterone Injection varies depending on the age, sex, and diagnosis of the individual patient. Transgender men and transmasculine individuals who take testosterone for gender dysphoria also report declines in dysphoria, depression, and anxiety. Sizar O, Schwartz J. Hypogonadism. is this a normal level? Consider referral to respirology, Initiate CPAP or oral device, refer to dietitian/ encourage lifestyle changes if overweight, monitor for changes in CPAP pressure requirements. Medically reviewed by Drugs.com. Transl Androl Urol. It is a common type of transgender hormone therapy (another being feminizing hormone . Cai Z, Xi H, Pan Y, et al. Testosterone Enanthate and Cypionate: 50 to 400 mg IM injection every 2 to 4 weeks. This practice involves the changing of dosage of a sex hormone so as to enhance positive effects and suppress negative effects. Before continuing this article, we need to state that we do not advise taking any kind of medications or hormone therapy without consulting with a medical professional. There may be utility in varying the timing of blood work to gather information regarding serum levels throughout the cycle (peak, mid-cycle, and trough), especially if a patient is reporting cyclic symptoms. Arch Intern Med. Proponents describe less discomfort for patients, a decreased rate of injection-site complications, and increased capacity for self-injection. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Barring contraindications, topical 2% lidocaine jelly may be applied vaginally 5-10 min prior to the procedure in those who find speculum examination painful due to atrophic changes. Testosterone is generally considered to be a safe and effective way for transmasculine people to affirm their gender identity. A practical target for hormone therapy for transgender women (MTF) is to decrease testosterone levels to the normal female range (30-100 ng/dl) without . Put the cup and cap back onto the bottle. 2016;5(6):877-884. doi:10.21037/tau.2016.09.04, Unger CA. Should you wish to only take hormones for a while, it is best to bring this to your doctors attention from the start. In addition, it is important to keep other people from touching the gel or skin after gel application. Apply Axiron to each clean, dry, intact skin of your underarm using an applicator. Alternatively, the oral dose is 160-250mg per day with food (broken up into two or three daily doses). A study reported in 2009 found that long-term testosterone treatment had an effect on the endometrium, the lining of the uterus 23. The degree and rate of physical effects is dependent on the dose and route of administration, as well as patient-specific factors such as age, genetics, body habitus and lifestyle. Follow your doctor's orders or the directions on the label. Learn about testosterone therapy as much as possible. Nassar GN, Leslie SW. Physiology, Testosterone. Keep from freezing. Some trans men will opt to undergo sex reassignment surgery, including removal of the breasts or genital surgery. For example, pelvic pain, acne, weight gain, atrophy of the vagina with vaginal dryness, clitoral discomfort, and in rare cases, infertility or other changes to the reproductive system. A common indication for testosterone therapy is treatment of decreased sexual desire or erectile dysfunction. Analogous to concerns of an increased risk of ovarian cancer in cis women with elevated androgen levels, it has been postulated that testosterone therapy in transmasculine patients may increase risk. 2017;177(4):471479. When people take testosterone to affirm their gender, it can lead to a number of permanent, irreversible changes in the body. Potter J, Peitzmeier SM, Bernstein I, Reisner SL, Alizaga NM, Agnor M, et al. information is beneficial, we may combine your email and website usage information with They are also often sold in higher doses than are advisable for the treatment of gender dysphoria, and they have far more risk factors associated with them. Drug class: Androgens and anabolic steroids. Remember that cisgender women should also have a certain level of testosterone in their systems, and if you start taking it as a supplement, your body gets used to not having to make it. It might require the doctor to come up with a different regimen that they usually use for long-term cases. JAMA Intern Med. Individual meets the following criteria: A. Patients who have been on a GnRH analogue for a significant length of time (2 years) without co-administration of exogenous testosterone. Some, but not all, transmasculine patients may feel uncomfortable with the idea of penetration and may feel their gender is undermined by the function of the speculum. For more information on metabolic effects please refer to the full Guidelines. Some evidence also suggests an increased risk of developing type 2 diabetes. Ask your doctor if you have any questions. Review/update the Elevation of liver enzymes may occur with testosterone therapy. . This therapy must be prolonged long term, even after the sex reassignment surgery (SRS). Hormone Therapy Considerations - Provincial Health Services Authority Although not formally indicated for testosterone replacement therapy in transgender men, it has become an increasingly popular option for some. 2018;86:135-144. Free of Charge Support for Surgeries. Testosterone usually is given through a shot, also called an injection, or through a gel or patch applied to the skin. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Please note that not all of these options are available in the US and Canada. An initial dose reduction of 10-15% can be considered if switching from IM to SC. Intramuscular testosterone injections are commonly used every one to two weeks.. and our We are aware that not everyone wants to undertake hormone therapy on a long-term basis. If you take an anticoagulant, your dosage may need adjusting. Testosterone treatment is not without side effects. DEPO-TESTOSTERONE Dosage and Administration (testosterone cypionate Fortesta should be applied to a clean, dry, intact skin of the front or inner thighs. Read our, Understanding Insurance Requirements for Gender Affirmation Surgery, Gender-Affirming Care Bans Harm More Than Just the Trans Community. In FTM testosterone therapy, testosterone (often called "T" for short) can be administered into the body in a number of ways. This is a way to deliverlong-lasting pellets of testosterone under the skin, reducing the frequency of treatment to once every three to six months. However, it is important to consider how trans patients may need a slightly different approach in some areas of primary care practice: tasks like disease prevention and screening, which may also require us to think differently. Rhoden EL, Estrada C, Levine L, Morgentaler A. Testosterone cypionate form of testosterone therapy is popular but is listed as an off-label treatment. J Clin Endocrinol Metab. 2020 Sherbourne Health | Rainbow Health Ontario | Site by Kelly Speck, Focused Physical Exam with PAP if indicated, PRIMED2: The back pocket guide for trans men and the men who love them, (see Canadas Low-risk Alcohol Drinking guidelines), RHO's Tips for Providing Paps to Trans men, 20 - 50 mg q weekly or 40 - 100 mg q 2 weeks, $73.50 per 5 mL vial (each vial contains 200 mg/mL x 5mL = 1000 mg), $64 per 10 mL vial (each vial contains 100mg/mL x 10mL =1000 mg), $164/60 x 2.5 mg patches $169/30 x 5 mg patches, 2.5 - 5 g daily (2-4 pumps, equivalent to 25 - 50 mg testosterone), 5 - 10 g daily (4-8 pumps, equivalent to 50 - 100 mg testosterone), $67/30 x 2.5 g sachets $110 / 30 x 5 g sachets $175 / 2 pump bottles, Consider daily migraine prophylaxis, consider transdermal route of administration, Identify and address barriers to optimal glycemic control, refer to dietitian, encourage lifestyle modification, initiate antiglycemic agent(s) per national guidelines, consider endocrinology referral, consider cardiac stress test, consider low dose/slow titration with monitoring, Identify and address barriers to optimal lipid control, refer to dietitian, initiate anti-lipemic pharmacologic therapy per national guidelines, consider endocrinology referral, consider cardiac stress test, consider low dose/slow titration with monitoring, Consider referral to cardiology, ensure optimal medical (including prophylactic anti-platelet agent(s) if indicated per national guidelines) and/or surgical management as indicated, risk factor optimization, consider transdermal route of administration, and/or low dose/slow titration with monitoring, Identify and address barriers to optimal BP control, initiate antihypertensive(s) as needed, consider cardiac stress test, consider low dose/slow titration with monitoring, consider referral to cardiology, Dependent on etiology, e.g. Am J Prev Med 2014;47(6):808-812. Apply an antiperspirant or deodorant spray at least 2 minutes before you apply this medicine. Most other physical changes are the kinds of changes that are the goal of gender transition. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Smoking cessation, stages of readiness, motivational interviewing, etc. They will be more familiar with the ins and outs of alternatives to testosterone, and there is a slight chance that you can take an alternative treatment in conjunction with testosterone (if your doctor advises it). This may help make the screening process less confusing or disturbing. Talking with a healthcare provider can help you understand the risks and benefits and determine the right type of testosterone for you and when to start testosterone therapy. Do not apply this medicine to your stomach, penis, scrotum, shoulders, or upper arms. Anastrozole: This medication stops the body from producing estrogen and is most often used in the treatment of breast cancer. The daily dosage of injected testosterone will depend on several factors, including your doctor's recommendations and your height and weight 3. Effect of testosterone deficiency on cholesterol metabolism in pigs fed a high-fat and high-cholesterol diet. The last side effect that is likely to be undesired is a change in bone structure density. FTM Facial Hair Growth: 11 Ways To Increase Hair Growth AndroGel 1.62% should only be applied to a clean, dry intact skin of the shoulders and upper arms. Follow cervical cancer screening guidelines as for cis women if the cervix is present. Proc (Bayl Univ Med Cent). So yours is actually comparatively low, but T works differently for everyone so your dose may be the right amount for you. Tremellen K,McPhee N,Pearce K,Benson S,Schedlowski M,Engler H. Endotoxin-initiated inflammation reducestestosteroneproduction in men of reproductive age. Wait for at least 2 hours (for AndroGel 1.62%, Fortesta, and Vogelxo) or 5 hours (for AndroGel 1%) after applying this medicine before showering or swimming. Verywell Health's content is for informational and educational purposes only. Hormone therapy for transgender patients. PLoS One. DOC Pharmacy Benefits Management Services Home Testosterone can be given as an injection, through a gel or patch on the skin, or through pellets placed under the skin. with a long-acting injection like Nebido), depending on the type of . Dosing Information for AndroGel (testosterone gel) 1.62% CIII Absolute contraindications for hormone therapy must be ruled-out prior to initiation of treatment. J Urol. . Jae Allen has been a writer since 1999, with articles published in "The Hub," "Innocent Words" and "Rhythm." The effect of testosterone levels on mood in men: a review. 2015;31(10):1911-4. Testosterone (Injectables and Implantable Pellets) Table of Contents . The effects of testosterone therapy include physical changes, like increased facial and body hair, increased muscle mass, and lower vocal pitch. 10 mg daily, by applying a single patch or combination of patches. If any medicine gets in your eyes, rinse them right away with water and call your doctor. 2006;155(6):773-81. A prospective study of 31 transgender men newly started on either subcutaneous 50-60mg/week testosterone cypionate, 5g/day 1% testosterone gel, or 4mg/day testosterone patch found that after 6 months only 21 (68%) achieved male range testosterone levels and 5 (16%) had persistent menses, with only 9 (29%) achieving physiologic male-range estradiol levels. Increased lean mass and muscle growth. Do not give it to anyone else, even if you have the same symptoms. Some basic contraindications for testosterone therapy include: You might also want to bring it to the attention of your doctor if you have a compromised immune system. And testosterone can't make you grow taller if your bones have already matured from early estrogen exposure. Name Starting dose Standard dose range Testosterone cypionate (cottonseed) 200mg/ml 0.15 ml -0.2 ml weekly 0.35 ml -0.5ml weekly or 0.7 ml -1 ml q 14 days Testosterone enanthate doi:10.1152/ajpendo.00279.2017. An Adaptive Preventive Care Checklist with accompanying explanations for trans-specific recommendations can be accessed below. It increases risk factors for other mental health disorders, and it is vital to address these before beginning treatment. Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases. This is actually a good idea for everyone. You may also empty the packet into the palm of your hand and then apply the medicine. Your doctor may adjust your dose as needed. Therapeutic doses of testosterone therapy are usually on par with normative levels present in cisgender men. Patel H, Arruarana V, Yao L, Cui X, Ray E. Effects of hormones and hormone therapy on breast tissue in transgender patients: a concise review. Clin Interv Aging. Estrogen, often in combination with a testosterone blocking medication, is used to reduce . For more information see next section on long-term preventive care. If you are using the gel in foil packets, tear the packet completely open along the perforation. Place the palm of your hand under the pump and press the pump the proper number of times to measure out your correct dose. 2019;8(6):784. the unsubscribe link in the e-mail. AndroGel is available in two dosage strengths: AndroGel 1% and AndroGel 1.62%. Adjust dose based on patient's response and appearance of adverse reactions. With over 2,800 cancer clinical trials underway at Mayo Clinic, your generous gift could help us find answers and change lives for people with cancer. Patients who have undergone oophorectomy and have been on low-dose or no exogenous testosterone for any significant length of time (>2 years). Testosterone Delatestryl AndroGel Androderm Typical Typical starting dose is 5-10 g per day if no physical or starting 50-80 mg every two weeks (or mental health concerns; start with dose 25-40 mg every week), gradually 2.5 g per day if there are increased each month until psychiatric problems or other Testosterone-based gender-affirming hormone therapy is the use of hormones to help a person develop a more masculine appearance. For example, if you've gone through puberty and grown breasts, testosterone may somewhat shrink the breast tissue, but won't remove the breasts entirely. A low dose of testosterone is prescribed, and then the dose is slowly increased over time. Desirable physical changes that can be caused by testosterone include: Transgender men and transmasculine individuals who take testosterone for gender dysphoria also report declines in dysphoria, depression, and anxiety. Click on one of the tabs to find out about routine care and screening suggestions. Dosage indicates 50-200mg injected per week, or 100-200mg injected every two weeks. doi:10.1080/08998280.2014.11929145. The medication is prescribed by, or in consultation with, an endocrinologist or a physician . All transmasculine patients should ensure a daily intake of 1000 IU Vitamin D and 1200mg of Calcium (total of diet + supplements). Lowering of vocal pitch. The goal of treatment is virilization the development of masculine secondary sexual characteristics. Overview of masculinizing hormone therapy - Gender Affirming Health Rinse the medicine discarded into the sink down the drain. Testosterone: is the most common hormone therapy option for transgender men. 2019 Mar 1;179(3):457]. 2008; 6:4. J Nutr Health Aging. Rinse the medicine discarded into the sink down the drain. For topical dosage form (solution): AdultsAt first, apply 60 milligrams (mg) (1 pump or 1 twist actuation of 30 mg) to each clean, dry, intact skin of your underarm once a day (usually in the morning). Testosterone Cypionate is also believed to cause higher rates of depressive symptoms than other forms of testosterone treatment. Hormone therapy can be used to promote physical characteristics reflective of one's gender identity or gender expression and relieve distress related to gender. Dosage ranges from 10-50mg injected every two to three weeks. Unfortunately, gender dysphoria is often associated with comorbid disorders and substance abuse just because of the intense anxiety and other feelings that can be related to gender dysphoria. Inadequate samples are common in patients on testosterone. Medical Management of FtM | Transgender Care Moncton FOLX Health - Microdosing (Low Dose) Testosterone HRT 2018 Mar 1;314(3):E206-E213. Asscheman H, Gooren LJ, Assies J, Smits JP, de Slegte R. Prolactin levels and pituitary enlargement in hormone-treated male-tofemale transsexuals. Some transmasculine patients may prefer to use the term chest over breast(s). Some individuals experience positive outcomes of a practice known as cycling. Rivas AM, Mulkey Z, Lado-Abeal J, Yarbrough S. Diagnosing and managing low serum testosterone. Testosterone propionate can be injected once or twice weekly in doses of 100 to 200 mg. A controlled clinical study reported in the "Journal of Sexual Medicine" in 2008 used a 1,000 mg weekly dose of injected testosterone over a period of 54 weeks 3. To provide you with the most relevant and helpful information, and understand which *Drug on VA National Formulary; Note: FtM testosterone doses are typically within the usual dosing range for hypogonadal conditions in biologic males. All rights reserved. She has worked as a medical writer, paralegal, veterinary assistant, stage manager, session musician, ghostwriter and university professor. This medicine comes with a Medication Guide and patient instructions. Specifically, it has a markedly reduced risk of resulting in hair loss over time and also has a more negligible effect on the skin. Testosterone Dosage : r/ftm - Reddit