Course of Testosterone Levels and Potential Biochemical Biomarkers of Androgenization with a Conservative Protocol of Androgen Hormone Therapy in Transgender Males.

Objectives: This study aimed to evaluate the hormonal, hematologic, and biochemical outcomes of a conservative protocol for androgen therapy for transgender males. Methods: This was an observational, prospective, and comparative study conducted in the gender identity clinic of a tertiary university hospital. Testosterone therapy consisted of testosterone cypionate administered intramuscularly every month at an initial dosage of 25 mg/month, which was increased to 50 mg/month at month 3, 100 mg/month at month 6, and 250 mg/month at month 9. Assessments consisted of a complete blood count, biochemical tests, urine analysis, and hormonal tests. We also administered the Transgender Congruence Scale (TCS) post hoc. Results: We recruited 40 transgender males with a mean (SD) age of 22.5 (8.4) years. Only changes in the hematocrit were statistically significant as early as month 9. There were no significant changes in the biochemical parameters related to cardiovascular risk, including serum lipids, over time. There was a significant increase in total, free, and bioavailable testosterone, while SHBG levels significantly decreased; the free androgen index, urine androstanediol glucuronide, androstenedione, and prostate-specific antigen as a marker of androgenization also significantly increased over time. Among the 20 evaluable individuals, 14 (70%) scored ≥4 on the appearance congruence subscale, and 16 (80%) scored ≥4 on the gender identity subscale of the TCS. Conclusions: Our results suggest that this conservative treatment paradigm with testosterone is associated with a reduced adverse impact on hematocrit and lipids but is sufficient to achieve the gender congruence and identity acceptance desired by transgender males.