Medicine alone does not completely suppress testosterone levels among transgender women

February 20, 2018, Boston University School of Medicine

The majority of transgender women who follow the usual approach prescribed in the United States are unable to reliably lower their testosterone levels into the typical female physiologic range with medicine alone.

The study, which appears in the journal Endocrine Practice, is the first to investigate the efficacy of transgender in terms of achieving targeted and subsequent stability of achieving over a prolonged period of several years.

Transgender individuals are those with different from external sexual anatomy at birth. Recent studies report that 0.6 percent of the adult population in the U.S. identify as transgender. A goal of transgender medical intervention is to align physical appearance with gender identity. The strategy for transgender women (male-to-female) includes medication and/or surgery to decrease or suppress levels into the female range. Most transgender women depend on medical treatment alone to lower their testosterone levels.

The researchers extracted testosterone and estradiol levels from the electronic medical records of 98 anonymized transgender women treated with oral spironolactone and oral estrogen therapy. Patients were separated into four similarly sized groups using the average estradiol dose they were administered over the course of their treatment. The Endocrine Society guidelines on monitoring transgender women suggests that patients should reach a serum testosterone <50ng/dl.

Only a quarter of transgender women taking a regimen of spironolactone and estrogens were able to lower testosterone levels within the usual female physiologic range. Another quarter could not achieve female levels but remained below the male range virtually all of the time, while one quarter was unable to achieve any significant suppression.

"This study allowed us to identify patients who achieved differing levels of testosterone suppression, including a group of patients unable to achieve any significant testosterone suppression. These patients may have had difficulty adhering to their treatment or may have had a different physiologic response to treatment than other patients. On the other hand, patients who were able to achieve high levels of suppression may have adhered stringently to their treatment or had robust response based on physiology," explained corresponding author Joshua D. Safer, MD, FACP, associate professor of medicine at Boston University School of Medicine.

"Also, it is not known if there is an absolute need for all transgender women to suppress the testosterone levels entirely into the female range. Perhaps it is acceptable for some to have levels just above the usual female upper limit."

The researchers believe future studies could pinpoint specific characteristics of patients who fall into each quartile of average steady state testosterone. "Identification of reasons why certain patients have better testosterone suppression could help improve anti-androgen therapy and allow for targeted interventions to advance the U.S. medical regimen for . As well, future study could determine the specific impact of testosterone at different levels even if not entirely in the female range," said Safer, also the Medical Director of the Center for Transgender Medicine and Surgery at Boston Medical Center.

.

Explore further: Transgender women who begin hormone therapy more likely to quit smoking

Related Stories

Transgender women who begin hormone therapy more likely to quit smoking

October 5, 2016
While there has been much concern about the potential harm from transgender medical intervention (hormone therapy), a new study has found that transgender women who receive hormone therapy are more likely to quit or decrease ...

Cross-sex hormones appear to be safe for transgender teens

April 12, 2017
(HealthDay)—Cross-sex hormones appear to be safe for transgender adolescents, according to a study published online April 6 in Pediatrics.

Study uncovers high prevalence of military sexual trauma among transgender veterans

November 21, 2016
New research found a high prevalence of military sexual trauma (MST) among transgender veterans and an association between the experience of MST and certain mental health conditions.

Researcher advises tracking transgender homicides

August 14, 2017
More research should be pursued about violence against transgender individuals, especially among young and Black or Latina transfeminine women, according to a recent study completed by Dr. Alexis Dinno, Sc.D., M.P.H., M.E.M., ...

Additional studies needed to evaluate CVD risks of hormone therapy for transgender patients

July 24, 2017
A new narrative review authored by Carl Streed Jr., MD, at Brigham and Women's Hospital, published in the Annals of Internal Medicine, discusses how more research is needed to better understand cardiovascular disease (CVD) ...

Direct patient care experience necessary for better transgender care

January 22, 2018
"There are simply are not enough physicians comfortable with treating transgender patients," according to Joshua D. Safer, MD, FACP, associate professor of medicine at Boston University School of Medicine (BUSM). To begin ...

Recommended for you

Study analyzes numbers, trends in health care data breaches nationwide

September 25, 2018
Health plans—entities that cover the costs of medical care—accounted for the greatest number of patient records breached over the past seven years, according to an analysis of U.S. health care data conducted by two Massachusetts ...

Genes may control how tough it is to stop drinking

September 25, 2018
(HealthDay)—When they give up booze, some alcoholics have more severe withdrawal symptoms than others. This discrepancy may come down to genetics, researchers say.

Why industry influence on research agendas must be addressed

September 25, 2018
Industry influence on the research agenda—and the tactics employed by tobacco, pharmaceutical, food, mining, chemical and alcohol companies to drive questions away from those most relevant to public health—is the focus ...

New study finds concurrent use of prescription drugs and dietary supplements could pose health risks

September 25, 2018
A new University of Hertfordshire study found that using certain over-the-counter herbal medicines and dietary supplements alongside prescription drugs could pose serious health risks, especially amongst older adults.

It's not just for kids—even adults appear to benefit from a regular bedtime

September 21, 2018
Sufficient sleep has been proven to help keep the body healthy and the mind sharp. But it's not just an issue of logging at least seven hours of Z's.

Most nations falling short of UN targets to cut premature deaths from chronic diseases

September 21, 2018
People in the UK, US and China have a higher risk of dying early from conditions like cancer, heart disease and stroke than people in Italy, France, South Korea and Australia.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.