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Current use of testosterone therapy in LGBTQ populations

International Journal of Impotence Research volume 34, pages 642–648 (2022)Cite this article

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Abstract

Testosterone therapy (TT) is a type of gender-affirming hormone therapy (GAHT) in lesbian, gay, bisexual, transgender, and genderqueer (LGBTQ) populations for gender dysphoria (GD), body uneasiness, and sexual dysfunction. The physical and physiological effects of TT vary widely depending on the dosing regimen and duration of treatment. An individualized approach prioritizing patient-specific desired effects in the context of pre-existing characteristics and health history is strongly recommended. Although TT is an effective treatment for many patients, there has been an increase in the illegitimate acquisition of TT in recent years. Non-judicious prescribing and lack of physician surveillance increases the risk of unintended side effects and potential serious health consequences.

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Fig. 1: Physical, physiologic, and mental status effects of TT.

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References

  1. Nieschlag E, Nieschlag S. Endocrine history: the history of discovery, synthesis and development of testosterone for clinical use. Eur J Endocrinol. 2019;180:R201–12.

    Article  CAS  PubMed  Google Scholar 

  2. Rastrelli G, Corona G, Maggi M. Testosterone and sexual function in men. Maturitas. 2018;112:46–52.

    Article  CAS  PubMed  Google Scholar 

  3. Tsametis CP, Isidori AM. Testosterone replacement therapy: for whom, when and how? Metabolism. 2018;86:69–78.

    Article  CAS  PubMed  Google Scholar 

  4. Vegunta S, Kling JM, Kapoor E. Androgen therapy in women. J Women’s Health. 2019;29:57–64.

    Article  Google Scholar 

  5. Radix A. Hormone therapy for transgender adults. Urol Clin North Am. 2019;46:467–73.

    Article  PubMed  Google Scholar 

  6. American Psychological Association. Guidelines for psychological practice with transgender and gender nonconforming people. Am Psychol. 2015;70:832–64.

    Article  Google Scholar 

  7. Defreyne J, T’Sjoen G. Transmasculine hormone therapy. Endocrinol Metab Clin North Am. 2019;48:357–75.

    Article  PubMed  Google Scholar 

  8. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DMS-5®). Washington, DC. American Psychiatric Pub; 2013.

  9. Nieschlag E, Nieschlag S. Testosterone deficiency: a historical perspective. Asian J Androl. 2014;16:161.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Morgentaler A, Traish A. The history of testosterone and the evolution of its therapeutic potential. Sex Med Rev. 2020;8:286–96.

    Article  PubMed  Google Scholar 

  11. Gagliano-Jucá T, Basaria S. Testosterone replacement therapy and cardiovascular risk. Nat Rev Cardiol. 2019;16:555–74.

    Article  PubMed  Google Scholar 

  12. Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) Study. 2022. NCT03518034. https://www.clinicaltrials.gov/ct2/show/NCT03518034. Accessed 21 Sept 2021.

  13. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2010;95:2536–59.

    Article  CAS  PubMed  Google Scholar 

  14. Mulhall JP, Trost LW, Brannigan RE, Kurtz EG, Redmon JB, Chiles KA, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200:423.

    Article  PubMed  Google Scholar 

  15. Bhasin S, Enzlin P, Coviello A, Basson R. Sexual dysfunction in men and women with endocrine disorders. Lancet. 2007;369:597–611.

    Article  CAS  PubMed  Google Scholar 

  16. Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males. Eur J Endocrinol. 2008;159:507–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Spitzer M, Huang G, Basaria S, Travison TG, Bhasin S. Risks and benefits of testosterone therapy in older men. Nat Rev Endocrinol. 2013;9:414–24.

    Article  CAS  PubMed  Google Scholar 

  18. Cunningham GR. Testosterone replacement therapy for late-onset hypogonadism. Nat Rev Urol. 2006;3:260–7.

    Article  CAS  Google Scholar 

  19. FDA Drug Safety Communication. FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. FDA. 2018. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due. Accessed 13 June 2021.

  20. Snyder PJ, Bhasin S, Cunningham GR, Matsumoto AM, Stephens-Shields AJ, Cauley JA, et al. Effects of testosterone treatment in older men. N. Engl J Med. 2016;374:611–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Cunningham GR, Stephens-Shields AJ, Rosen RC, Wang C, Bhasin S, Matsumoto AM, et al. Testosterone treatment and sexual function in older men with low testosterone levels. J Clin Endocrinol Metab. 2016;101:3096–104.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Roy CN, Snyder PJ, Stephens-Shields AJ, Artz AS, Bhasin S, Cohen HJ, et al. Association of testosterone levels with anemia in older men: a controlled clinical trial. JAMA Intern Med. 2017;177:480.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Dimopoulou C, Ceausu I, Depypere H, Lambrinoudaki I, Mueck A, Pérez-López FR, et al. EMAS position statement: testosterone replacement therapy in the aging male‏. Maturitas. 2016;84:94–99.

    Article  CAS  PubMed  Google Scholar 

  24. Isidori AM, Balercia G, Calogero AE, Corona G, Ferlin A, Francavilla S, et al. Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. J Endocrinol Investig. 2015;38:103–12.

    Article  CAS  Google Scholar 

  25. Layton JB, Li D, Meier CR, Sharpless JL, Stürmer T, Jick SS, et al. Testosterone lab testing and initiation in the United Kingdom and the United States, 2000 to 2011. J Endocrinol Metab. 2014;99:835–42.

    Article  CAS  Google Scholar 

  26. Handelsman DJ. Global trends in testosterone prescribing, 2000–2011: expanding the spectrum of prescription drug misuse. Med J Aust. 2013;199:548–51.

    Article  PubMed  Google Scholar 

  27. Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med. 2013;173:1465.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Purcell DW, Wolitski RJ, Hoff CC, Parsons JT, Woods WJ, Halkitis PN. Predictors of the use of viagra, testosterone, and antidepressants among HIV-seropositive gay and bisexual men. AIDS. 2005;19:S57–S66.

    Article  CAS  PubMed  Google Scholar 

  29. Hackett G, Kirby M, Wylie K, Heald A, Ossei-Gerning N, Edwards D, et al. British society for sexual medicine guidelines on the management of erectile dysfunction in men—2017. J Sex Med. 2018;15:430–57.

    Article  PubMed  Google Scholar 

  30. Hackett GI, Cole NS, Deshpande AA, Popple MD, Kennedy D, Wilkinson P. Biochemical hypogonadism in men with type 2 diabetes in primary care practice. Br J Diabetes Vasc. 2009;9:226–31.

    Article  CAS  Google Scholar 

  31. Cui Y, Zong H, Yan H, Zhang Y. The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2014;17:132–43.

    Article  CAS  PubMed  Google Scholar 

  32. Hackett GI. Testosterone replacement therapy and mortality in older men. Drug Saf. 2016;39:117–30.

    Article  CAS  PubMed  Google Scholar 

  33. Hodgson TK, Braunstein GD Physiological Effects of Androgens in Women. In: Azziz R, Nestler JE, Dewailly D (eds). Androgen Excess Disorders in Women. 2nd ed. Totowa, NJ: Humana Press; 2007. p. 49–62.

  34. Elraiyah T, Sonbol MB, Wang Z, Khairalseed T, Asi N, Undavalli C, et al. The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99:3536–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N. Engl J Med. 2008;359:2005–17.

    Article  CAS  PubMed  Google Scholar 

  36. Braunstein GD, Sundwall DA, Katz M, Shifren JL, Buster JE, Simon JA, et al. Safety and efficacy of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial. Arch Intern Med. 2005;165:1582–9.

    Article  CAS  PubMed  Google Scholar 

  37. Somboonporn W, Bell RJ, Davis SR. Testosterone for peri and postmenopausal women. Cochrane Database Syst Rev. 2005;4:CD004509.

    Google Scholar 

  38. Panzer C, Guay A. Testosterone replacement therapy in naturally and surgically menopausal women. J Sex Med. 2009;6:8–18.

    Article  CAS  PubMed  Google Scholar 

  39. Davis SR, Braunstein GD. Efficacy and safety of testosterone in the management of hypoactive sexual desire disorder in postmenopausal women. J Sex Med. 2012;9:1134–48.

    Article  CAS  PubMed  Google Scholar 

  40. Dimitrakakis C, Jones RA, Liu A, Bondy CA. Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy. Menopause. 2004;11:531–5.

    Article  PubMed  Google Scholar 

  41. Nachtigall L, Casson P, Lucas J, Schofield V, Melson C, Simon JA. Safety and tolerability of testosterone patch therapy for up to 4 years in surgically menopausal women receiving oral or transdermal oestrogen. Gynecol Endocrinol. 2011;27:39–48.

    Article  CAS  PubMed  Google Scholar 

  42. Clayton AH, Goldstein I, Kim NN, Althof SE, Faubion SS, Faught BM, et al. The International Society for the Study of Women’s Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women. Mayo Clin Proc. 2018;93:467–87.

    Article  PubMed  Google Scholar 

  43. Wierman ME, Arlt W, Basson R, Davis SR, Miller KK, Murad MH, et al. Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014;99:3489–510.

    Article  CAS  PubMed  Google Scholar 

  44. UCSF Transgender Care, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. Deutsch MB (ed). 2nd ed. June 2016. transcare.ucsf.edu/guidelines.

  45. Cocchetti C, Ristori J, Romani A, Maggi M, Fisher AD. Hormonal treatment strategies tailored to non-binary transgender individuals. J Clin Med. 2020;9:1609.

    Article  CAS  PubMed Central  Google Scholar 

  46. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgend. 2012;13:165–232.

    Article  Google Scholar 

  47. Heylens G, Verroken C, Cock SD, T’Sjoen G, Cuypere GD. Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with a gender identity disorder. J Sex Med. 2014;11:119–26.

    Article  PubMed  Google Scholar 

  48. Fisher AD, Castellini G, Ristori J, Casale H, Cassioli E, Sensi C, et al. Cross-sex hormone treatment and psychobiological changes in transsexual persons: two-year follow-up data. J Clin Endocrinol Metab. 2016;101:4260–9.

    Article  CAS  PubMed  Google Scholar 

  49. Fisher AD, Castellini G, Bandini E, Casale H, Fanni E, Benni L, et al. Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria. J Sex Med. 2014;11:709–19.

    Article  CAS  PubMed  Google Scholar 

  50. Zucker KJ. Epidemiology of gender dysphoria and transgender identity. Sex Health. 2017;14:404–11.

    Article  PubMed  Google Scholar 

  51. Johns MM, Lowry R, Andrzejewski J, Barrios LC, Demissie Z, McManus T, et al. Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students—19 States and Large Urban School Districts, 2017. MMWR Morb Mortal Wkly Rep. 2019;68:67–71.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102:3869–903.

    Article  PubMed  Google Scholar 

  53. Beckwith N, Reisner SL, Zaslow S, Mayer KH, Keuroghlian AS. Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults. Transgend Health. 2017;2:156–64.

    Article  PubMed  PubMed Central  Google Scholar 

  54. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality. 2016. https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf. Accessed 19 June 2021.

  55. Moravek MB. Gender-affirming hormone therapy for transgender men. Clin Obstet Gynecol. 2018;61:687–704.

    Article  PubMed  Google Scholar 

  56. Fabris B, Bernardi S, Trombetta C. Cross-sex hormone therapy for gender dysphoria. J Endocrinol Investig. 2015;38:269–82.

    Article  CAS  Google Scholar 

  57. Irving A, Lehault WB. Clinical pearls of gender-affirming hormone therapy in transgender patients. Ment Health Clin. 2017;7:164–7.

    Article  PubMed  Google Scholar 

  58. Miller MG, Rogol AD, ZumBrunnen TL. Secondary exposure to testosterone from patients receiving replacement therapy with transdermal testosterone gels. Curr Med Res Opin. 2012;28:267–9.

    Article  CAS  PubMed  Google Scholar 

  59. Costa LB, Rosa-e-Silva A, Medeiros S, Nacul A, Carvalho B, Benetti-Pinto C, et al. Recommendations for the use of testosterone in male transgender. Rev Bras Ginecol Obstet. 2018;40:275–80.

    Article  PubMed  Google Scholar 

  60. T’Sjoen G, Arcelus J, Gooren L, Klink DT, Tangpricha V. Endocrinology of transgender medicine. Endocr Rev. 2019;40:97–117.

    Article  PubMed  Google Scholar 

  61. Baker KE, Wilson LM, Sharma R, Dukhanin V, McArthur K, Robinson KA. Hormone therapy, mental health, and quality of life among transgender people: a systematic review. J Endocr Soc. 2021;5:bvab011.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Colton Meier SL, Fitzgerald KM, Pardo ST, Babcock J. The Effects of Hormonal Gender Affirmation Treatment on Mental Health in Female-to-Male Transsexuals. J Gay Lesbian. J Gay Lesbian Ment Health. 2011;15:281–99.

    Article  Google Scholar 

  63. Moreno-Arrones OM, Becerra A, Vano-Galvan S. Therapeutic experience with oral finasteride for androgenetic alopecia in female-to-male transgender patients. Clin Exp Dermatol. 2017;42:743–8.

    Article  CAS  PubMed  Google Scholar 

  64. Leiblum S, Bachmann G, Kemmann E, Colburn D, Swartzman L. Vaginal atrophy in the postmenopausal woman: the importance of sexual activity and hormones. JAMA. 1983;249:2195–8.

    Article  CAS  PubMed  Google Scholar 

  65. Miyajima T, Kim YT, Oda H. A study of changes in bone metabolism in cases of gender identity disorder. J Bone Min Metab. 2012;30:468–73.

    Article  CAS  Google Scholar 

  66. Goh HH, Ratnam SS. Effects of hormone deficiency, androgen therapy and calcium supplementation on bone mineral density in female transsexuals. Maturitas. 1997;26:45–52.

    Article  CAS  PubMed  Google Scholar 

  67. Kesteren PV, Lips P, Gooren LJG, Asscheman H, Megens J. Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones. Clin Endocrinol. 1998;48:347–54.

    Article  Google Scholar 

  68. Connelly PJ, Marie Freel E, Perry C, Ewan J, Touyz RM, Currie G, et al. Gender-affirming hormone therapy, vascular health and cardiovascular disease in transgender adults. Hypertension. 2019;74:1266–74.

    Article  CAS  PubMed  Google Scholar 

  69. Walker WH. Non-classical actions of testosterone and spermatogenesis. Philos Trans R Soc Lond B Biol Sci. 2010;365:1557–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Smith LB, Walker WH. The regulation of spermatogenesis by androgens. Semin Cell Dev Biol. 2014;30:2–13.

    Article  CAS  PubMed  Google Scholar 

  71. Gu Y, Liang X, Wu W, Liu M, Song S, Cheng L, et al. Multicenter contraceptive efficacy trial of injectable testosterone undecanoate in Chinese men. J Clin Endocrinol Metab. 2009;94:1910–5.

    Article  CAS  PubMed  Google Scholar 

  72. Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. 2014;124:1120–7.

    Article  CAS  PubMed  Google Scholar 

  73. Moravek MB. Fertility preservation options for transgender and gender-nonconforming individuals. Curr Opin Obstet Gynecol. 2019;31:170–6.

    Article  PubMed  Google Scholar 

  74. Practice Committee of the American Society for Reproductive Medicine. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril. 2019;112:1022–33.

  75. Cobo A, Bellver J, Domingo J, Pérez S, Crespo J, Pellicer A, et al. New options in assisted reproduction technology: the Cryotop method of oocyte vitrification. Repro Biomed Online. 2008;17:68–72.

    Article  Google Scholar 

  76. Mitu K. Transgender reproductive choice and fertility preservation. AMA J Ethics. 2016:18:1119–25.

    Article  PubMed  Google Scholar 

  77. Jasuja GK, Bhasin S, Rose AJ. Patterns of testosterone prescription overuse. Curr Opin Endocrinol Diabetes Obes. 2017;24:240–5.

    Article  PubMed  Google Scholar 

  78. Xavier JM. The Washington, DC Transgender Needs Assessment Survey. Administration for HIV/Aids of the District of Columbia Government. 2000. http://www.glaa.org/archive/2000/tgneedsassessment1112.shtml. Accessed 13 June 2021.

  79. Rotondi NK, Bauer GR, Scanlon K, Kaay M, Travers R, Travers A. Nonprescribed Hormone Use and Self-Performed Surgeries: “Do-It-Yourself” Transitions in Transgender Communities in Ontario, Canada. Am J Public Health. 2013;103:1830–6.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Mepham N, Bouman WP, Arcelus J, Hayter M, Wylie KR. People with Gender Dysphoria Who Self‐Prescribe Cross‐Sex Hormones: Prevalence, Sources, and Side Effects Knowledge. J Sex Med. 2014;11:2995–3001.

    Article  PubMed  Google Scholar 

  81. Stroumsa D, Crissman HP, Dalton VK, Kolenic G, Richardson CR. Insurance Coverage and Use of Hormones Among Transgender Respondents to a National Survey. Ann Fam Med. 2020;18:528–34.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. University of Texas Dell Medical School, Austin, TX, 78712, USA

    A. N. Tijerina, A. V. Srivastava, V. R. Patel & E. C. Osterberg

  2. Dell Medical School Department of Surgery and Perioperative Care and Ascension Seton Hospital Network, Austin, TX, 78712, USA

    E. C. Osterberg

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ANT and ECO conceived and designed the manuscript. ANT, AVS, and VRP collected data, interpreted findings, and drafted the manuscript with support from ECO. All authors participated in critical revision and agreed on final approval of the manuscript.

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Tijerina, A.N., Srivastava, A.V., Patel, V.R. et al. Current use of testosterone therapy in LGBTQ populations. Int J Impot Res 34, 642–648 (2022). https://doi.org/10.1038/s41443-021-00490-z

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