Masculinizing hormone therapy Flashcards
True or False
Testosterone therapy prevent pregnancy
- Testosterone therapy does not prevent pregnancy even if amenorrhea is achieved.
- Testosterone is a teratogen thus reliable contraception may be required depending on sexual practices.
Gel formulations have the risk of what ?
- of inadvertent exposures to others who come into contact with the patient’s skin.
- This is of particular importance for patients with young children and/or with intimate partners who are pregnant or considering pregnancy.
Name Contraindications : Testosterone (6)
- Pregnancy or breast feeding
- Active known sex-hormone-sensitive cancer (e.g., breast, endometrial)
- Unstable ischemic cardiovascular disease
- Poorly controlled psychosis or acute homicidality
- Psychiatric conditions which limit the ability to provide informed consent
- Hypersensitivity to one of the components of the formulation
Name recommended doses for testosterone IM/SC
* Starting dose
* Maximum dose
- Starting dose : 20–50 mg q weekly or 40–100 mg q 2 weeks
- Maximum dose : 100 mg q weekly or 200 mg q 2 weeks
Name physical effects of testosterone (10)
- Skin oiliness/acne
- Body fat redistribution
- Increased muscle mass/strength (Significantly dependent on amount of exercise)
- Facial/body hair growth
- Scalp hair loss (Highly dependent on age and inheritance; may be minimal)
- Cessation of menses
- Clitoral enlargement
- Vaginal Atrophy
- Deepened voice
- Infertility
Name IRREVERSIBLE physical effects of testosterone (4)
- Facial/body hair growth
- Scalp hair loss
- Clitoral enlargement
- Deepened voice
Standard monitoring of testosterone should how ?
- be employed at baseline, 3, 6, and 12 months; and yearly thereafter.
- Some clinicians prefer to see patients monthly until an effective dose is established.
Titration of doses will generally occur how in injectable testosterone ? (3)
- in the early phases of treatment.
- For example, with injectable testosterone, a starting dose of 30 mg injected weekly could be increased by 10–20 mg every ** 4–6 weeks**.
- Speed of titration will depend on lab results, patient goals, response, and side effects.
For those using an injectable route, there may be utility in varying the timing of blood work. Why ?
to gather information regarding serum hormone levels throughout the cycle (peak, mid-cycle, and trough), especially if a patient is reporting cyclic symptoms.
Hormone levels for those seeking a more androgynous appearance may be what?
intentionally be mid-range between male and female norms.
Describe risk of supraphysiologic levels of testosterone
- Supraphysiologic levels should be avoided due to the increased risk of adverse events and side effects, as well the potential for the aromatization of excess testosterone into estrogen.
- Dose reduction is warranted if supraphysiologic doses are measured at mid-cycle or trough.
Describe bleeding/spotting with testosterone
- There may be some irregular bleeding or spotting in the first few months of treatment.
- However, once sustained menstrual cessation is achieved, any vaginal bleeding without explanation (e.g. missed dose(s) or lowered dose of testosterone) warrants a full workup for endometrial hyperplasia/cancer.
True or False
Clinical effects are the goal of therapy, not specific lab values.
- Clinical effects are the goal of therapy, not specific lab values.
- If the sex marker associated with the patient’s health card has not been changed, the reported reference ranges will refer to the sex assigned at birth. Reference ranges vary between laboratories - refer to reference ranges from the specific laboratory (often available online or by request from the lab).
Name bloodwork at baseline ()
- CBC
- ALT
- HbA1c or Fasting Glucose
- Lipid profile
- Total Testosterone
- LH Post-gonadectomy (Elevated LH may have implications regarding bone mineral density (See full Guidelines)
