Background

Reassignment of a female-to-male (FtM) person requires gender-affirming, androgenic hormonal treatment that is planned to induce appropriate structural changes. This therapy must be prolonged long term, even after the sex reassignment surgery (SRS). The purpose of this study is to evaluate the effects of hormone therapy with testosterone in FtM subjects during a 24-month follow-up in order to highlight the occasional need for early decompensation and to make adequate hormone therapy modulations.

Methods

Fifteen out of 23 FtM persons had been previously treated with SRS, while eight were still awaiting surgery. During hormone therapy, both groups were followed for 24 months, with evaluation of desired changes, adverse effects, and functional or metabolic indicators.

Results

In the group of operated FtM subjects (15/23), a significant increase of total testosterone (total T) and free testosterone (free T) was found after 24 months. Luteinizing hormone (LH) maintained a low level, decreasing after ovariectomy, while FSH increased. Voice deepening, facial and body hair variation, male-pattern balding, and body mass index (BMI) increase are all physical changes due to androgenization. In both groups of patients who have been closely monitored, the side effects and thromboembolic, metabolic, and cardiovascular risks of androgen therapy, even in the long term, appear to be irrelevant.

Conclusion

Total T, free T, and LH dosages are shown to be reliable markers of correct androgenization. Strict monitoring of lipid profile, evaluation of BMI and hematocrit, avoidance of self-initiated therapeutic modifications, adherence to a healthy lifestyle, and avoidance of excessive daily calorie intake can limit risks linked to long-term testosterone administration.

Trial registration

Retrospectively registered

中文翻译：

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女性到男性跨性别患者的激素治疗：寻求终生平衡

背景

女性变男性 (FtM) 人的重新分配需要性别肯定的雄激素治疗，计划诱导适当的结构变化。即使在变性手术 (SRS) 之后，这种疗法也必须长期延长。本研究的目的是在 24 个月的随访期间评估睾酮激素治疗对 FtM 受试者的影响，以强调偶尔需要早期失代偿并进行适当的激素治疗调节。

方法

23 名 FtM 人中有 15 人之前曾接受过 SRS 治疗，而 8 人仍在等待手术。在激素治疗期间，两组均随访 24 个月，评估预期变化、不良反应以及功能或代谢指标。

结果

在 FtM 手术组 (15/23) 中，24 个月后发现总睾酮 (total T) 和游离睾酮 (free T) 显着增加。促黄体生成素 (LH) 保持低水平，卵巢切除后下降，而 FSH 增加。声音变深、面部和体毛变化、男性型秃顶和体重指数 (BMI) 增加都是由雄激素化引起的身体变化。在密切监测的两组患者中，雄激素治疗的副作用和血栓栓塞、代谢和心血管风险，即使是长期的，似乎也无关紧要。

结论

总 T、游离 T 和 LH 剂量被证明是正确雄激素化的可靠标志。严格监测血脂状况、评估 BMI 和血细胞比容、避免自我发起的治疗调整、坚持健康的生活方式以及避免每日摄入过多的卡路里可以限制与长期服用睾酮相关的风险。

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