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HRT in Women
cypionate dose protocols for woman
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<blockquote data-quote="madman" data-source="post: 263234" data-attributes="member: 13851"><p>Female-to-male (FTM).</p><p></p><p>Main goal of masculinizing GAHT is to promote virilization which is achieved by treating women with testosterone therapy using doses of T that result in serum testosterone concentrations in the male reference range.</p><p></p><p></p><p><strong><em>*The overall goals of testosterone therapy for transgender men are to <u>obtain secondary sexual characteristics of natal men, to live their lives as men, to improve their wellbeing, and to decrease gender dysphoria</u>. <u>Because androgen receptors are widely distributed, testosterone therapy has diverse effects throughout the body, affecting both physical and psychological characteristics</u> (figure)</em></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>Testosterone therapy for transgender men (2017)</strong></p><p><em>Michael S Irwig</em></p><p><em></em></p><p><em></em></p><p><em><strong>Testosterone therapy is a cornerstone of medical treatment for transgender men who choose to undergo it. The goal of testosterone therapy is usually to <u>achieve serum testosterone concentrations in the male reference range</u>. Testosterone has several desired effects as well as undesired and unknown effects. The <u>desired effects include increased facial and body hair, increased lean mass and strength, decreased fat mass, deepening of the voice, increased sexual desire, cessation of menstruation, clitoral enlargement, and reductions in gender dysphoria, perceived stress, anxiety, and depression</u>.</strong> <strong>Achievement of these goals comes with potential undesired effects and risks including <u>acne, alopecia, reduced HDL cholesterol, increased triglycerides, and a possible increase in systolic blood pressure</u>. An additional benefit of testosterone therapy (with or without mastectomy) is a reduced risk of breast cancer. <u>Most of the effects of testosterone start to develop within several months of starting therapy, although facial hair and alopecia continue to develop after 1 year</u>. </strong>A major limitation in the study of testosterone therapy for transgender men is a paucity of high-quality data due to a shortage of randomized controlled trials (partly because of ethical issues), few prospective and long-term studies, the use of suboptimum control groups, loss to follow-up, and difficulties in recruitment of representative samples of transgender populations.</em></p><p></p><p></p><p></p><p><strong>Introduction</strong></p><p></p><p><em><strong>Many transgender people seek medical care to obtain hormone therapy for masculinization or feminization.</strong> <strong><u>The mainstay of treatment is testosterone for a transgender man (also referred to as transman or female-to-male transgende</u></strong><u><strong>r)</strong></u><strong> or estrogen and antiandrogens for a transgender woman (also referred to as transwoman or male-to-female transgender).</strong></em></p><p></p><p></p><p><strong><em>In this Review, I focus on the <u>effects of testosterone therapy on various organ systems in adult transgender men</u>. <u>Because the extent of the effects of testosterone can vary by type of testosterone formulation, this information is included where possible</u>. <u>Where applicable, comparisons will be made with the effects of testosterone therapy in men with hypogonadism and natal women</u>. These comparisons have limitations because of the different host environment in natal men and the lower doses of testosterone that are given to natal women. Importantly, endogenous testosterone concentrations are generally 10–20 times higher in men than in women.</em></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>Intended effects of testosterone therapy </strong></p><p><strong></strong></p><p><strong>Overview</strong></p><p></p><p><em><strong>The overall goals of testosterone therapy for transgender men are to <u>obtain secondary sexual characteristics of natal men, to live their lives as men, to improve their wellbeing, and to decrease gender dysphoria</u>. <u>Because androgen receptors are widely distributed, testosterone therapy has diverse effects throughout the body, affecting both physical and psychological characteristics (figure)</u>.</strong> <strong>No standard practice exists for starting doses or maintenance doses of testosterone.</strong> <strong>In clinical practice, I usually initiate therapy at a low dose (ie, 50 mg intramuscular testosterone cypionate every 2 weeks) and <u>gradually increases the dose to a full adult male replacement dose (ie, 200 mg intramuscular testosterone cypionate every 2 weeks), as if treating a man with hypogonadism</u>. Periodic hormone measurements are obtained to aid in the titration.</strong> Testosterone therapy is generally regarded as safe in the short term, but much less is known about its long-term effects. <strong>Table 2 shows the doses, advantages, and disadvantages of the principal formulations of testosterone that are available around the world. Although many formulations of testosterone exist, research about transgender men has mainly been restricted to intramuscular esters, long-acting intramuscular testosterone undecanoate, and topical gels.</strong> The effects of testosterone therapy in transgender men should not be generalized to men with hypogonadism or postmenopausal women, who are given much lower doses.</em></p><p></p><p></p><p></p><p></p><p><strong>Figure: Effects of testosterone therapy in transgender men</strong></p><p><strong>[ATTACH=full]36316[/ATTACH]</strong></p><p><strong>[ATTACH=full]36318[/ATTACH]</strong></p><p></p><p> </p><p></p><p></p><p><strong>Endocrinology of Transgender Medicine (2018)</strong></p><p><em>Guy T’Sjoen,1,2 Jon Arcelus,3,4 Louis Gooren,5 Daniel T. Klink,6 and Vin Tangpricha7</em></p><p></p><p></p><p><strong>ABSTRACT</strong></p><p></p><p><em> Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role.<strong> The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health.</strong> The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. <strong>The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair.</strong> Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid–related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population. (Endocrine Reviews 40: 97 – 117, 2019)</em></p><p></p><p></p><p></p><p></p><p><strong>Hormonal treatment in transgender men</strong></p><p><strong></strong></p><p><strong>Testosterone</strong></p><p></p><p><em>The principal hormonal treatment used to i<strong>nduce virilization is testosterone. </strong></em></p><p></p><p></p><p></p><p></p><p><strong>Virilization in transgender men</strong></p><p></p><p><em><strong>Treatment in transgender men is intended to induce virilization. <u>This includes cessation of menses, development of male physical contours, a deepening of the voice, clitoral growth, increased sexual desire, and increased facial and body hair (Fig. )</u> (108, 110, 111). Male pattern baldness may also occur. Changes in body composition, with redistribution of body fat and increased muscle mass and strength, have been described extensively (40, 44, 112)</strong>. The time period before cessation of menses may vary from 1 to 12 months after testosterone initiation, sometimes requiring the addition of a progestational agent (40, 113). Mean clitoral length may reach 3.83 ± 0.42 cm after 2 years of testosterone therapy (43)</em></p><p></p><p></p><p></p><p></p><p></p><p></p><p>[MEDIA=youtube]n96RUnQyF-s[/MEDIA]</p><p></p><p></p><p>[ATTACH=full]36306[/ATTACH]</p><p>[ATTACH=full]36307[/ATTACH]</p><p>[ATTACH=full]36308[/ATTACH]</p><p>[ATTACH=full]36312[/ATTACH]</p><p></p><p></p><p></p><p></p><p><strong><em>*Typically, goal testosterone is 400-700ng/dL. If using injections, check testosterone mid-way between doses.</em></strong></p><p>[ATTACH=full]36309[/ATTACH]</p><p>[ATTACH=full]36314[/ATTACH]</p></blockquote><p></p>
[QUOTE="madman, post: 263234, member: 13851"] Female-to-male (FTM). Main goal of masculinizing GAHT is to promote virilization which is achieved by treating women with testosterone therapy using doses of T that result in serum testosterone concentrations in the male reference range. [B][I]*The overall goals of testosterone therapy for transgender men are to [U]obtain secondary sexual characteristics of natal men, to live their lives as men, to improve their wellbeing, and to decrease gender dysphoria[/U]. [U]Because androgen receptors are widely distributed, testosterone therapy has diverse effects throughout the body, affecting both physical and psychological characteristics[/U] (figure)[/I] Testosterone therapy for transgender men (2017)[/B] [I]Michael S Irwig [B]Testosterone therapy is a cornerstone of medical treatment for transgender men who choose to undergo it. The goal of testosterone therapy is usually to [U]achieve serum testosterone concentrations in the male reference range[/U]. Testosterone has several desired effects as well as undesired and unknown effects. The [U]desired effects include increased facial and body hair, increased lean mass and strength, decreased fat mass, deepening of the voice, increased sexual desire, cessation of menstruation, clitoral enlargement, and reductions in gender dysphoria, perceived stress, anxiety, and depression[/U].[/B] [B]Achievement of these goals comes with potential undesired effects and risks including [U]acne, alopecia, reduced HDL cholesterol, increased triglycerides, and a possible increase in systolic blood pressure[/U]. An additional benefit of testosterone therapy (with or without mastectomy) is a reduced risk of breast cancer. [U]Most of the effects of testosterone start to develop within several months of starting therapy, although facial hair and alopecia continue to develop after 1 year[/U]. [/B]A major limitation in the study of testosterone therapy for transgender men is a paucity of high-quality data due to a shortage of randomized controlled trials (partly because of ethical issues), few prospective and long-term studies, the use of suboptimum control groups, loss to follow-up, and difficulties in recruitment of representative samples of transgender populations.[/I] [B]Introduction[/B] [I][B]Many transgender people seek medical care to obtain hormone therapy for masculinization or feminization.[/B] [B][U]The mainstay of treatment is testosterone for a transgender man (also referred to as transman or female-to-male transgende[/U][/B][U][B]r)[/B][/U][B] or estrogen and antiandrogens for a transgender woman (also referred to as transwoman or male-to-female transgender).[/B][/I] [B][I]In this Review, I focus on the [U]effects of testosterone therapy on various organ systems in adult transgender men[/U]. [U]Because the extent of the effects of testosterone can vary by type of testosterone formulation, this information is included where possible[/U]. [U]Where applicable, comparisons will be made with the effects of testosterone therapy in men with hypogonadism and natal women[/U]. These comparisons have limitations because of the different host environment in natal men and the lower doses of testosterone that are given to natal women. Importantly, endogenous testosterone concentrations are generally 10–20 times higher in men than in women.[/I] Intended effects of testosterone therapy Overview[/B] [I][B]The overall goals of testosterone therapy for transgender men are to [U]obtain secondary sexual characteristics of natal men, to live their lives as men, to improve their wellbeing, and to decrease gender dysphoria[/U]. [U]Because androgen receptors are widely distributed, testosterone therapy has diverse effects throughout the body, affecting both physical and psychological characteristics (figure)[/U].[/B] [B]No standard practice exists for starting doses or maintenance doses of testosterone.[/B] [B]In clinical practice, I usually initiate therapy at a low dose (ie, 50 mg intramuscular testosterone cypionate every 2 weeks) and [U]gradually increases the dose to a full adult male replacement dose (ie, 200 mg intramuscular testosterone cypionate every 2 weeks), as if treating a man with hypogonadism[/U]. Periodic hormone measurements are obtained to aid in the titration.[/B] Testosterone therapy is generally regarded as safe in the short term, but much less is known about its long-term effects. [B]Table 2 shows the doses, advantages, and disadvantages of the principal formulations of testosterone that are available around the world. Although many formulations of testosterone exist, research about transgender men has mainly been restricted to intramuscular esters, long-acting intramuscular testosterone undecanoate, and topical gels.[/B] The effects of testosterone therapy in transgender men should not be generalized to men with hypogonadism or postmenopausal women, who are given much lower doses.[/I] [B]Figure: Effects of testosterone therapy in transgender men [ATTACH type="full" alt="Screenshot (27738).png"]36316[/ATTACH] [ATTACH type="full" alt="Screenshot (27739).png"]36318[/ATTACH][/B] [B]Endocrinology of Transgender Medicine (2018)[/B] [I]Guy T’Sjoen,1,2 Jon Arcelus,3,4 Louis Gooren,5 Daniel T. Klink,6 and Vin Tangpricha7[/I] [B]ABSTRACT[/B] [I] Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role.[B] The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health.[/B] The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. [B]The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair.[/B] Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid–related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population. (Endocrine Reviews 40: 97 – 117, 2019)[/I] [B]Hormonal treatment in transgender men Testosterone[/B] [I]The principal hormonal treatment used to i[B]nduce virilization is testosterone. [/B][/I] [B]Virilization in transgender men[/B] [I][B]Treatment in transgender men is intended to induce virilization. [U]This includes cessation of menses, development of male physical contours, a deepening of the voice, clitoral growth, increased sexual desire, and increased facial and body hair (Fig. )[/U] (108, 110, 111). Male pattern baldness may also occur. Changes in body composition, with redistribution of body fat and increased muscle mass and strength, have been described extensively (40, 44, 112)[/B]. The time period before cessation of menses may vary from 1 to 12 months after testosterone initiation, sometimes requiring the addition of a progestational agent (40, 113). Mean clitoral length may reach 3.83 ± 0.42 cm after 2 years of testosterone therapy (43)[/I] [MEDIA=youtube]n96RUnQyF-s[/MEDIA] [ATTACH type="full" alt="Screenshot (27724).png"]36306[/ATTACH] [ATTACH type="full" alt="Screenshot (27725).png"]36307[/ATTACH] [ATTACH type="full" alt="Screenshot (27726).png"]36308[/ATTACH] [ATTACH type="full" alt="Screenshot (27731).png"]36312[/ATTACH] [B][I]*Typically, goal testosterone is 400-700ng/dL. If using injections, check testosterone mid-way between doses.[/I][/B] [ATTACH type="full" alt="Screenshot (27728).png"]36309[/ATTACH] [ATTACH type="full" alt="Screenshot (27733).png"]36314[/ATTACH] [/QUOTE]
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ExcelFemale
HRT in Women
cypionate dose protocols for woman
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