madman
Super Moderator
ABSTRACT
Introduction: The evidence on gender-affirming hormonal treatment (HT) for transgender persons is still insufficient.
Aim: To characterize the physical and psychological effects of HT using testosterone enanthate in transgender men, and to validate the safety of this treatment.
Methods: A total of 85 Japanese transgender men who were followed up for at least 1 year at our gender clinic from 2004 to 2017 were included in this study. All self-reported effects that they recognized and regularly acquired laboratory data were investigated after initiation of HT.
Main Outcome Measure: HT mainly using testosterone enanthate 250 mg every 2 weeks caused the most desired physical effects to appear promptly and effectively, whereas small but not negligible numbers of undesired physical and psychological effects were also confirmed.
Results: The initial dose of testosterone enanthate was 250 mg for 72 (84.7%) subjects, and the injection interval was maintained every 2 weeks for 70 (82.3%). Most physical effects appeared within 6 months. A deepened voice (87.1%), cessation of menses (78.8%), acne (69.4%), and facial (52.9%)/body (37.6%) hair growth occurred within 3 months. Although recognition of psychological effects was rare, emotional instability (9.4%) and increased libido (7.1%) appeared in the relatively early phase after beginning HT. The mean values for red blood cells, hemoglobin, uric acid, and alkaline phosphatase were significantly increased for 2 years. During the observation period, there were no life-threatening adverse effects in any subjects.
Conclusion: The present HT strategy is effective and safe for Japanese transgender men. The information from self-reported effects and objective data from blood tests can help both physicians and transgender men to understand testosterone.
INTRODUCTION
The terminologies transgender and gender incongruence are applied for persons with gender identities that are not aligned with the sex assigned at birth.1 If gender incongruence persists and leads to distress, there can be gender dysphoria.2 Although the basis of treatment for transgender persons is mental support, if discomfort persists for a certain period, physical treatments (gender-affirming treatment) to align appearance with gender identity would be recommended. One of them is hormonal treatment (HT).
HT using exogenous testosterone is administered to transgender men.3 Although the recommended treatment methods and general masculinizing effects of testosterone HT are referred to in guidelines,3 many other side effects are also suggested.4 Furthermore, psychological effects have been noted.5 On the other hand, the data for Japanese transgender men have not been elucidated. In Japan, the medical expenses of HT for transgender persons are not covered by health care insurance at present, and there is no guideline for proper HT enforcement. Therefore, verification of the effects and safety of HT has been insufficient, and the accumulation of evidence about HT is important.
In this study, we set a testable hypothesis that all kinds of effects of testosterone HT for Japanese transgender men would be appeared at the same time and frequency as previously reported, and safety is also guaranteed. We focused on the details of testosterone HT and aimed to clarify the subjective and objective effects of HT via physical and psychological profiles. We intended to determine what kinds of effects occurred and when these effects were recognized by the patients themselves after beginning HT.
*Physical and Psychological Effects of Hormone Treatment
*Blood Tests
DISCUSSION
The goals of HT are to suppress endogenous sex hormone secretion determined by the person's genetic/gonadal sex and to maintain sex hormone levels within the normal range for the person's affirmed gender.3 For transgender men, an androgen is given to induce masculinization, and “desired side effects” of the androgen. Although it is desirable that these side effects appear early and effectively, there is no guideline for proper use in Japan. In the clinical practice guidelines of the endocrine society,3 recommended HT regimens are described. In the case of testosterone enanthate, it is indicated that this preparation should be injected at a dose of 100 mg to 200 mg every 2 weeks. Then the serum total testosterone level should be measured every 3 months until the values are in the normal physiological male range. Moreover, the testosterone level should be measured at intermediate times between injections and adjusted as per the results.3
*Finally, the limitations of this study should be addressed. First, this study was retrospective, so we may not have extracted all the effects that the participants recognized. In addition, we could not evaluate the degrees of these effects. When one effect occurred at one point in time, it might have disappeared at other points. Second, there were no strict criteria about the dose and interval of testosterone, as these were determined by each physician. Third, the reported psychological effects were the subjective emotions of each individual and thus might lack objectivity. Therefore, a prospective study evaluating the chronological changes of each effect using validated questionnaires is needed in the future. However, the present study clarified subjective and objective physical and psychological effects due to testosterone HT as far as possible in a relatively large number of Japanese transgender men.
CONCLUSION
We retrospectively investigated the influences of gender-affirming hormone treatment using intramuscular testosterone enanthate in Japanese transgender men. Most of the results were similar to those reported previously. However, small but not negligible numbers of non-desired physical and psychological effects considered to be due to HT were also confirmed.
Introduction: The evidence on gender-affirming hormonal treatment (HT) for transgender persons is still insufficient.
Aim: To characterize the physical and psychological effects of HT using testosterone enanthate in transgender men, and to validate the safety of this treatment.
Methods: A total of 85 Japanese transgender men who were followed up for at least 1 year at our gender clinic from 2004 to 2017 were included in this study. All self-reported effects that they recognized and regularly acquired laboratory data were investigated after initiation of HT.
Main Outcome Measure: HT mainly using testosterone enanthate 250 mg every 2 weeks caused the most desired physical effects to appear promptly and effectively, whereas small but not negligible numbers of undesired physical and psychological effects were also confirmed.
Results: The initial dose of testosterone enanthate was 250 mg for 72 (84.7%) subjects, and the injection interval was maintained every 2 weeks for 70 (82.3%). Most physical effects appeared within 6 months. A deepened voice (87.1%), cessation of menses (78.8%), acne (69.4%), and facial (52.9%)/body (37.6%) hair growth occurred within 3 months. Although recognition of psychological effects was rare, emotional instability (9.4%) and increased libido (7.1%) appeared in the relatively early phase after beginning HT. The mean values for red blood cells, hemoglobin, uric acid, and alkaline phosphatase were significantly increased for 2 years. During the observation period, there were no life-threatening adverse effects in any subjects.
Conclusion: The present HT strategy is effective and safe for Japanese transgender men. The information from self-reported effects and objective data from blood tests can help both physicians and transgender men to understand testosterone.
INTRODUCTION
The terminologies transgender and gender incongruence are applied for persons with gender identities that are not aligned with the sex assigned at birth.1 If gender incongruence persists and leads to distress, there can be gender dysphoria.2 Although the basis of treatment for transgender persons is mental support, if discomfort persists for a certain period, physical treatments (gender-affirming treatment) to align appearance with gender identity would be recommended. One of them is hormonal treatment (HT).
HT using exogenous testosterone is administered to transgender men.3 Although the recommended treatment methods and general masculinizing effects of testosterone HT are referred to in guidelines,3 many other side effects are also suggested.4 Furthermore, psychological effects have been noted.5 On the other hand, the data for Japanese transgender men have not been elucidated. In Japan, the medical expenses of HT for transgender persons are not covered by health care insurance at present, and there is no guideline for proper HT enforcement. Therefore, verification of the effects and safety of HT has been insufficient, and the accumulation of evidence about HT is important.
In this study, we set a testable hypothesis that all kinds of effects of testosterone HT for Japanese transgender men would be appeared at the same time and frequency as previously reported, and safety is also guaranteed. We focused on the details of testosterone HT and aimed to clarify the subjective and objective effects of HT via physical and psychological profiles. We intended to determine what kinds of effects occurred and when these effects were recognized by the patients themselves after beginning HT.
*Physical and Psychological Effects of Hormone Treatment
*Blood Tests
DISCUSSION
The goals of HT are to suppress endogenous sex hormone secretion determined by the person's genetic/gonadal sex and to maintain sex hormone levels within the normal range for the person's affirmed gender.3 For transgender men, an androgen is given to induce masculinization, and “desired side effects” of the androgen. Although it is desirable that these side effects appear early and effectively, there is no guideline for proper use in Japan. In the clinical practice guidelines of the endocrine society,3 recommended HT regimens are described. In the case of testosterone enanthate, it is indicated that this preparation should be injected at a dose of 100 mg to 200 mg every 2 weeks. Then the serum total testosterone level should be measured every 3 months until the values are in the normal physiological male range. Moreover, the testosterone level should be measured at intermediate times between injections and adjusted as per the results.3
*Finally, the limitations of this study should be addressed. First, this study was retrospective, so we may not have extracted all the effects that the participants recognized. In addition, we could not evaluate the degrees of these effects. When one effect occurred at one point in time, it might have disappeared at other points. Second, there were no strict criteria about the dose and interval of testosterone, as these were determined by each physician. Third, the reported psychological effects were the subjective emotions of each individual and thus might lack objectivity. Therefore, a prospective study evaluating the chronological changes of each effect using validated questionnaires is needed in the future. However, the present study clarified subjective and objective physical and psychological effects due to testosterone HT as far as possible in a relatively large number of Japanese transgender men.
CONCLUSION
We retrospectively investigated the influences of gender-affirming hormone treatment using intramuscular testosterone enanthate in Japanese transgender men. Most of the results were similar to those reported previously. However, small but not negligible numbers of non-desired physical and psychological effects considered to be due to HT were also confirmed.
