If you are taking testosterone as part of your hormone replacement therapy, your doctor will try to keep your levels within the normal range for a long time. Some patients may choose to undergo testosterone treatment for a period of time to develop these irreversible changes and then discontinue treatment with testosterone and return to their endogenous estrogen hormone environment. Transgender men with physiological male and amenorrhoeic testosterone levels are expected to have H&H values within the normal male range. The most common fear that prevents women from following testosterone therapy is that they fear develop masculine traits.
If you are taking testosterone as part of your HRT and your level is too high, your dose is likely to decrease. You'll need to check your testosterone levels every 6 to 12 months, even if you notice an increase in your sexual desire and your testosterone levels are within the recommended range. If you are taking testosterone as part of your hormone replacement therapy, your doctor will try to keep your levels within the normal range in people younger than 50. Since the dosage indicated on the label (not included in the table) of these medications is based on the treatment of men with low but not zero testosterone levels, higher doses may be needed in transgender men (see table) than those commonly used in non-transgender men.
Those who go through medically or surgically induced menopause experience a more dramatic drop in testosterone and, as a result, may have problems with more serious symptoms. Testosterone levels can be difficult to measure in non-transgender men due to rapid fluctuations in levels related to the pulsatile release of gonadotropins. There is not enough data at this time, but early research suggests that there may be a link between increased testosterone levels and certain types of cancer. Once hormone levels have reached the target range for a specific patient, it is reasonable to monitor levels annually. In addition, individual genetic and physiological variation can cause wide variations in blood levels and response to treatment among different individuals using the same route and dose.
If an amenorrhoeic transgender man taking testosterone has an H&H above the female upper limit, but below the male upper limit, providers should refer to the normal H&H values from their laboratory and disregard the highest levels reported. As with testosterone replacement in non-transgender men, annual visits and laboratory checks are sufficient for transgender men who follow a stable hormonal regimen. Changing to a more frequent injection schedule (maintaining the same total amount of testosterone over time) or to using transdermal preparations may limit the risk of polycythemia. Once total testosterone exceeds the midpoint value in the laboratory-reported reference range, it is not clear if an increase in dosage will have any positive effect on the perception of slow progress or on mood symptoms or other side effects.
