Testosterone Patches in Post-op Female-to-Male Transsexuals
Asscheman H., Gooren L. J.
Abstract [Full Text] [PDF]
The aim of testosterone treatment in female-to-male transsexuals is a serum testosterone level in or close to the male range that induces the secondary male characteristics, as bear growth and muscle development and suppresses the menstrual cycle (pre-operatively). Intramuscular testosterone esters 200-250 mg/2 weeks is an efficacious therapy used by the majority of f-t-m transsexuals with good results. However, intra muscular injections of the oily solution of testosterone esters can be painful and serum levels of testosterone increase to supraphysiologic values in the days after the injection and decrease to low levels in 10-17 days. These fluctuations in serum levels of testosterone are reported by them as lack of energy or irritability when serum testosterone levels are low. With the next injection, the symptoms disappear but recur before the following injection is due. With oral testosterone undecenoate serum testosterone levels are lower than the male range and suppression of the menstrual cycle occurs in only 50%. Another disadvantage is that testosterone undecenoate has to be taken 2-3 times/day.
Post-operatively the aim of testosterone treatment is to treat hot flushes, to maintain male characteristics and to prevent osteoporosis. Both injections and oral testosterone are used but a number of f-t-ms are not satisfied or non-compliant with the available treatments. They complain about the pain of the injections or mood swings with intramuscular testosterone and persistent hot flushes or decreased effect with oral testosterone undecenoate. Transdermal scrotal testosterone patches have been used for 10 years in male hypogonadal patients and result in stable testosterone levels in the male range with few side effects. Patches that could be applied to other areas of the body have recently been developed. The skin in other areas of the body is thicker and chemicals (enhancers) are necessary to increase the permeability of the skin for testosterone. Unfortunately, the enhancers also cause skin irritation in >50% of the patients (Androderm). Testoderm TTS is supposed to have less irritating effect on the skin. Therefore, we decided to perform a pilot study.
Ten female-to-male transsexuals who were not satisfied with their actual treatment discontinued testosterone therapy for 6 weeks. Fasting blood samples were obtained for basal values and symptoms were recorded. After 6 weeks on Testoderm TTS, serum levels of testosterone were taken 3-5 hours after they had applied the patch. After 3 months they returned in the morning with the patch of the previous day still on in order to obtain serum testosterone levels after wearing the patch for >24 hours. Mean serum testosterone levels 3-5 hours after the new patch were 15.7=4,1 nmol/1 and after 24 hours 8,6=2,7 nmol/1 (male range 8-36 nmol/1). Hot flushes and ‘night sweating’ decreased in all and disappeared in the majority. They reported a more stable mood and better energy. Applying the patch once a day was after some experimenting for the best area (lower thorax or hip) rated as easy. They did not feel the patch during the day and removing it was painless.
Our first experiences with Testoderm TTs body patches show promising results: testosterone levels are in the male range even after 24 hours, symptoms of lack of testosterone are less or disappear, daily use was no problem and no subject experienced side effects. A larger number of subjects and long follow up is necessary to confirm our results.
Citation: IJT, Volume 5, Number 4, October – December 2001 an article published on the Internet by the International Journal of Transgenderism <http://www.symposion.com/ijt/>