Treatment
16
Table 14. Monitoring of Transgender Persons on Gender-
Affirming Hormone Therapy: Transgender Male
1. Evaluate patient every 3 mo in the first year and then one to two times per year to
monitor for appropriate signs of virilization and for development of adverse reactions
2. Measure serum testosterone every 3 mo until levels are in the normal physiologic
male range:
a
a. For testosterone enanthate/cypionate injections, the testosterone level should
be measured midway between injections. The target level is 400–700 ng/dL.
Alternatively, measure peak and trough levels to ensure levels remain in the
normal male range
b. For parenteral testosterone undecanoate, testosterone should be measured just
before the following injection. If the level is <400 ng/dL, adjust dosing interval
c. For transdermal testosterone, the testosterone level can be measured no sooner
than after 1wk of daily application (≥2 h after application)
3. Measure hematocrit or hemoglobin at baseline and every 3 mo for the first year and
then one to two times a year. Monitor weight, blood pressure, and lipids at regular
intervals
4. Screening for osteoporosis should be conducted in those who stop testosterone
treatment, are not compliant with hormone therapy, or who develop risks for bone
loss
5. If cervical tissue is present, monitor as recommended by the American College of
Obstetricians and Gynecologists
6. Ovariectomy can be considered after completion of hormone transition
7. Conduct sub- and peri-areolar annual breast examinations if mastectomy performed.
If mastectomy is not performed, then consider mammograms as recommended by the
American Cancer Society.
a
Adapted from Lapauw et al. Bone. 2008;43(6):1016–1021. and Ott et al. Fertil Steril.
2010;93(4):1267–1272.
