Testosterone therapy does not always induce amenorrhea in female to male transgender subjects

Transgender men are persons assigned female at birth but who identify themselves as men. Cross sex testosterone therapy is the milestone of medical treatment for transgender men; its aim is to achieve serum testosterone... [ view full abstract ]

Transgender men are persons assigned female at birth but who identify themselves as men.
Cross sex testosterone therapy is the milestone of medical treatment for transgender men; its aim is to achieve serum testosterone concentrations in the physiological male reference range in order to develop male secondary sex characteristics and to induce the regression of female ones.
One of the most desired effects is the suppression of menses for the high symbolic negative value attributed to the cyclic menstrual bleeding: however, in some cases testosterone treatment is not sufficient to gain this effect, increasing patients’ psychological distress.
In case of persistent bleeding, Endocrine Society guidelines suggest to add a progestational agent or to use GnRH analogs or depot medroxyprogesterone acetate (MAP).

The aim of our retrospective study was to find differences between Female to Male (FtM) subjects achieving amenorrhea (group 0) and FtM subjects with persistent menses (group 1) after 1 year of continuous testosterone treatment. [ view full abstract ]

The aim of our retrospective study was to find differences between Female to Male (FtM) subjects achieving amenorrhea (group 0) and FtM subjects with persistent menses (group 1) after 1 year of continuous testosterone treatment.

In our gender dysphoria clinic in Turin 50 FtM subjects were retrospectively analysed before (T0) and after 1 year (T1) of continuous testosterone treatment. At T0 age, BMI, serum testosterone and estradiol levels have been... [ view full abstract ]

In our gender dysphoria clinic in Turin 50 FtM subjects were retrospectively analysed before (T0) and after 1 year (T1) of continuous testosterone treatment.
At T0 age, BMI, serum testosterone and estradiol levels have been analyzed.
At T1 BMI, serum testosterone and estradiol levels, obtainement of amenorrhea and second line treatment in case of persistent bleedings have been evaluated.
Amenorrhea is defined by the absence of menstrual bleedings for at least 3 consecutive months.

Achievement of amenorrhea and second line treatment in case of persisting bleedings at T1 were the main outcomes of our study. [ view full abstract ]

Achievement of amenorrhea and second line treatment in case of persisting bleedings at T1 were the main outcomes of our study.

After 12 months of continuous testosterone treatment, all patients reached male serum testosterone levels (5,13 [3,78-7,62] ng/ml) and attained a satisfactory body virilization. 64 % of our sample obtained amenorrhea (group... [ view full abstract ]

After 12 months of continuous testosterone treatment, all patients reached male serum testosterone levels (5,13 [3,78-7,62] ng/ml) and attained a satisfactory body virilization.
64 % of our sample obtained amenorrhea (group 0) and 36 % showed persistent menses (group 1).
There were no differences between the two groups in terms of age, BMI, testosterone and estradiol levels.
Testosterone levels at T1 were divided into quartiles both in group 0 and in group 1: a higher number of subjects with T concentrations in the upper quartiles reached amenorrhea; however no significant differences were found between the two groups.
6 FtM (33,3% in group 1) accepted this condition with no discomfort, while 12 FtM (66,6 % in group 1) desired a second line treatment to stop bleedings.
In 11/12 of these subjects we used progestinic agents, but bleedings persisted or recurred in 8 of them (72,7 %).
In 1/12 anastrozole was used, obtaining amenorrhea.
Finally, we retrospectively considered age, estrogen and testosterone levels in T0, type of treatment (injective or transdermal testosterone preparations or both) and BMI as predictive factors in group 1, but none of them significantly influenced the achievement of amenorrhea.

In conclusion, one year testosterone therapy in FtM transgender subjects lead to a good body virilization and reduces gender dysphoria distress, although more than one third of subjects did not obtain amenorrhea. Since the... [ view full abstract ]

In conclusion, one year testosterone therapy in FtM transgender subjects lead to a good body virilization and reduces gender dysphoria distress, although more than one third of subjects did not obtain amenorrhea.
Since the persistence of menstrual bleedings is a further cause of discomfort, obtaining amenorrhea is still a matter of concern for transgender men and for all professionals involved in the management of gender dysphoria.