In FtMs testosterone (TE) therapy is used to pursue the dual objective of suppressing female secondary sex characteristics and inducing a male phenotype to the patient. Between October 2001 and December 2018, an heterogeneous group of 32 patients (Pts) with a mean age of 27.7 years presented to our Center for FtM Gender Dysphoria. We analyzed Body Mass Index (BMI), haemochrome and hormonal (LH, FSH, Prolactin) measurements comparing baseline levels to post-therapy. A total of 10/32 showed adrenal androgen levels above the upper reference range (TE, Δ4A, DHEAs); pre-therapy mean TE was 0.6 ng/ml. 25/32 Pts were treated with im TE enanthate (TEe) and 7/32 with im TE undecanoate (TEu) at different dosages; a total of 4 Pts were switched from TEe to TEu during the follow-up. Pts with a baseline BMI <30 kg/m2 showed a mean BMI increase of 0.61.2 kg/m2 after starting TE administration; we observed maximum BMI increase after 12-18 months of treatment. Two Pts with a pre-therapy BMI >30 kg/m2 showed a BMI decrease of −7.9 and −1.1 kg/m2 after 24 and 18 months of treatment respectively. Hematocrit (Hct), Haemoglobin (Hb), and Red Blood Cells count showed a similar increasing trend, with maximum values after 918 months of treatment; Hct reached values >50% (maximum 54.6%) in a total of 7 Pts, two of which treated with TEu; in those Pts Cardioaspirin was added to hormonal therapy (as suggested by haematologists). Each patient required, as was predictable, a different and tailored TE dose. TEe dosage ranged from 80 mg/21 days to 250 mg/15 days, whereas TEu one ranged from 1000 mg/12 weeks to 1000 mg/21 weeks. TEu therapy provided more stable levels of testosterone, whereas spikes and drops in testosterone levels were observed during TEe treatment. During the initial follow-up 8/32 Pts (25%) complained of persistent uterine bleeding; 7 of them were taking TEe, 1 TEu. In 5 Pts bleedings easily disappeared after increasing the testosterone dose. None of our Pts developed hypertension. No cases of ovarian pathology were detected; but it might be considered that bilateral ovariectomy could prevent the development of ovarian malignancies. The BMI increase of 0.61.2 kg/m2 after treatment might be due to fluid retention, or an increase in lean body mass or fat mass. TE administration in FtM transsexuals appears to be effective in maintaining testosterone levels within physiological limits, well tolerated and very safe with no differences among the testosterone formulations used.
18 - 21 May 2019
European Society of Endocrinology