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…