Hormone therapy for trans men aims to:

• Masculinize secondary sexual characteristics, e.g., facial hair growth, deepening of the voice, muscle development.
• Reduce female traits, such as breast tissue and menstruation.
• Improve psychological well-being by aligning the body with the experienced gender identity.

Process and Administration of Testosterone Therapy

1. Before Starting Therapy

Several steps are required before initiating hormone therapy:

• Psychological Evaluation: Diagnosis of gender incongruence according to ICD-11 or DSM-5.
• Counseling on the goals, side effects, and risks of therapy.
• Medical Examinations:
  • Hormone levels (LH, FSH, testosterone, estradiol)
  • Complete blood count, liver function, lipid profile, blood glucose
  • Bone mineral density in cases of osteoporosis risk
  • Screening for comorbidities (e.g., diabetes, hypertension)
• Fertility Counseling: Egg freezing should be considered for those who wish to preserve fertility before therapy.

2. Administration of Testosterone

Hormone therapy is primarily carried out using testosterone, which can be administered in different forms:

1. Intramuscular Injections
   • Preparations: Testosterone enanthate or testosterone cypionate.
   • Dosage: 50–100 mg weekly or 100–200 mg every 2 weeks.
   • Adjustment: Dosage is individualized to achieve male testosterone levels (300–1000 ng/dl).
2. Transdermal Preparations (Gels or Patches)
   • Preparations: Testosterone gel (e.g., Testogel®, Tostran®)
   • Dosage: 2.5–5 g of gel per day (equivalent to approximately 50–100 mg testosterone).
   • Advantages: Steady hormone absorption, simple application.
   • Disadvantages: Requires daily application; skin contact with others must be avoided.
3. Oral Testosterone Preparations
   • Less commonly used due to liver strain.
4. Testosterone Implants (Pellets)
   • Long-term effect (3–6 months), rarely used.

• Effects of Hormone Therapy

The first changes typically occur within 6–12 months:

Early Effects (1–6 months):

• Deepening of the voice (irreversible)
• Cessation of menstruation (after 2–6 months)
• Increased sebum production: Oily skin and acne.

Mid-Term Effects (6–12 months):

• Facial and body hair growth
• Increased muscle mass and strength
• Fat redistribution: From hips to abdomen and shoulders.

Long-Term Effects (1–5 years):

• Breast tissue atrophy: Reduction in breast volume.
• Reduced bone density without adequate therapy.
• Suppression of ovarian function: Ovaries produce fewer hormones.
• Side Effects and Risks

Hormone therapy requires medical supervision due to potential side effects:

• Acne and oily skin
• Hair loss (androgenic alopecia)
• Increased cholesterol and risk of cardiovascular disease
• Increased blood pressure and hemoglobin levels (polycythemia)
• Liver damage with incorrect dosage or oral preparations
• Mood swings and increased aggressiveness (rare)
• Long-Term Monitoring

Regular medical check-ups are essential to monitor hormone levels and detect potential side effects early:

• Testosterone levels in blood (every 3–6 months)
• Lipid profile and liver function (annually)
• Bone density for osteoporosis risk
• Blood pressure and blood count to monitor for polycythemia

6. Complementary Measures

• Surgical Procedures: Chest masculinization surgery (mastectomy), hysterectomy, or construction of male genitalia.
• Psychological Support: Assistance with social and emotional challenges during the transition.

Conclusion

Hormone therapy is a key component of gender-affirming treatment for female to male transition. It enables a gradual masculinization of the body but requires close medical supervision to minimize risks and achieve the best possible outcomes.

The hormone therapy for gender-affirming treatment in gender incongruence (transsexuality) from male to female (trans women) aims to align male physical characteristics to a female appearance. The therapy primarily involves estrogens and antiandrogens to suppress male hormones and promote female characteristics.