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

A co-worker's rudeness can affect your sleep—and your partner's, study finds

December 14, 2018
Rudeness. Sarcastic comments. Demeaning language. Interrupting or talking over someone in a meeting. Workplace incivilities such as these are becoming increasingly common, and a new study from Portland State University and ...

A holiday gift to primary care doctors: Proof of their time crunch

December 14, 2018
The average primary care doctor needs to work six more hours a day than they already do, in order to make sure their patients get all the preventive and early-detection care they want and deserve, a new study finds.

Teens get more sleep with later school start time, researchers find

December 12, 2018
When Seattle Public Schools announced that it would reorganize school start times across the district for the fall of 2016, the massive undertaking took more than a year to deploy. Elementary schools started earlier, while ...

Large restaurant portions a global problem, study finds

December 12, 2018
A new multi-country study finds that large, high-calorie portion sizes in fast food and full service restaurants is not a problem unique to the United States. An international team of researchers found that 94 percent of ...

Receiving genetic information can change risk

December 11, 2018
Millions of people in the United States alone have submitted their DNA for analysis and received information that not only predicts their risk for disease but, it turns out, in some cases might also have influenced that risk, ...

Yes please to yoghurt and cheese: The new improved Mediterranean diet

December 11, 2018
Thousands of Australians can take heart as new research from the University of South Australia shows a dairy-enhanced Mediterranean diet will significantly increase health outcomes for those at risk of cardiovascular disease ...

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.