Transgender man medical care

Transgender man medical care

I recently attended a medical conference and listened to a fabulous transgender care lecture.  Here are the pearls that I learned…

Masculinizing medications:

Only testosterone.

  • Goal of testosterone is 300 – 1000. There is large range for testosterone.  Testosterone level over 1000 causes problem with increased red blood cell mass. 
  • The masculinizing change takes upwards of 3-5 years for masculinization to take effect.  Usually within 6 months, the voice has completely changed and this is an irreversible effect of testosterone.  
  • Testosterone cypionate is usually given under the skin (and does not need to be injected into the muscle).  Gel is a popular option, but these are expensive and often not covered by insurance. Testosterone pellets (Testepell) is used as a subdermal implant that is inserted every 3 months.
  •  Labs: testosterone level.
  •  Estradiol level does not matter much.
  • Goal for testosterone is within the male-range. Monitor red blood cell mass. Hematocrit less than 55 is the goal. Be sure to hydrate with water with blood work drawn.

Masculinization surgery:

  1. Removal of uterus and ovaries. Ob/gyn perform this surgery.
  2. After 2 years of testosterone the clitoris can be formed into a phallus.  Metoidioplasty (done at many sites) and phalloplasty (staged surgeries over a year or two. Complicated.  Only done at a few centers around the country) may be considered.

Patients still need primary care!

Physician should take organ-inventory to make sure that all organs are screened for.

  • For example, transgender men who have a cervix need pap smears to screen for cervical cancer).
  • If transmen miss a testosterone dose (and have vaginal intercourse with men) they can get pregnant.  What is the contraception method?
  • Mammogram.  If breasts were mostly removed and chest contouring was performed, there is still some breast tissue present.  Consider breast u/s or MRI may be needed (there may not be enough breast tissue to squeeze in a mammogram machine).

I hope this helps…


About drlesliegreenberg

I have been practicing as a family physician for over 20 years--as both an educator of physicians and clinician. From infancy to the elderly, I perform obstetrics and general medicine. I love my career and am passionate about my field of knowledge and my patients. Follow me on Facebook at Leslie Md Greenberg Medical Disclaimer The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
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