Information about Hormone Regimens

List of topics in this document

Prescribing for Transmen

Testosterone Options

• Injectable Testosterone - Sustanon

• Injectable Testosterone - Testosterone Enanthate

• Injectable Testosterone - Testosterone Undecanoate Injection (Nebido)

• Gel - Testogel Pump

• Gel - Testogel Sachets

• Gel - Tostran Pump

Monitoring Requirements for Transmen

• Testosterone

• Estradiol

• Blood Pressure

• FBC

• LFTs

• Lipids

• HbA1c

• Calcium

• Cervical Smear

• Breast Cancer Screening

Prescribing for Transmen

Injectable Testosterone - Sustanon

Brand names: Sustanon

Starting dose: 250 mg every 4 weeks

Directions: 1ml injection IM. Avoid in peanut/soya allergy

Frequency/dose range: 2-6 weeks

Further treatment: If periods persist after 6 months of adequate testosterone treatment, a GnRH agonist such as Leuprorelin (11.25mg 3 monthly) or a long-acting form of progestogenic contraception can be added.

Injectable Testosterone - Testosterone Enanthate

Brand names: Testosterone enanthate

Starting dose: 250 mg every 4 weeks

Directions: 1ml injection IM

Frequency/dose range: 2-6 weeks

Further treatment: [Same as Sustanon]

Injectable Testosterone - Testosterone Undecanoate Injection (Nebido)

Brand names: Nebido

Starting dose: 1000 mg every 12 weeks

Directions: 4ml IM injection into buttock. Starting regimen may have second dose at 6 weeks then third dose at 12 weeks when initiating.

Frequency/dose range: 8-26 weeks maintenance dosing frequency.

Further treatment: [Same as Sustanon]

Gel - Testogel Pump

Brand names: Testogel pump 16.2mg/g topical gel (20.25 mg per actuation)

Starting dose: 1-2 actuations daily (20.25-40.5 mg)

Directions: Apply to clean, dry, healthy skin of both inner thighs or abdomen.

Frequency/dose range: 40.5-81mg once daily

Further treatment: [Same as Sustanon]

Gel - Testogel Sachets

Brand names: Testogel sachets 50mg/5g topical gel (50mg per sachet)

Starting dose: 50mg daily

Directions: [Apply to clean, dry, healthy skin of both inner thighs or abdomen]

Frequency/dose range: 50-100mg once daily

Further treatment: [Same as Sustanon]

Gel - Tostran Pump

Brand names: Tostran pump 20 mg/1g topical gel (10 mg per actuation)

Starting dose: 1-2 actuation daily (10-20mg)

Directions: [Apply to clean, dry, healthy skin of both inner thighs or abdomen]

Frequency/dose range: 20-80mg once daily

Further treatment: [Same as Sustanon]

Monitoring Requirements for Transmen

Testosterone

Action: Initial monitoring at 4 months but would be later for Nebido. Trough level (immediately before injection or if not possible within two days prior to injection) on Sustanon; mid-way between injections on Nebido (although can be a trough sample of logistically easier); 4 to 6 hours after application of gel if applied in morning first thing in the morning if gel applied in evening. Target: Lower third reference range for trough level on injection; middle third reference range on gel or midway between Nebido injections. If outside target range, increase/decrease as appropriate: injection frequency by 1 week for Sustanon, 2 weeks for Nebido; or gel dose by 10mg.

Estradiol

Action: Usually aim for less than 400 pmol/l with suppression of menstruation, however if there are no periods this may be variable.

Blood Pressure

Action: May increase. The clinician can diagnose and treat hypertension as appropriate.

FBC

Action: Can cause polycythaemia (a high concentration of red blood cells in the blood). Testosterone should be withheld if haematocrit (PCV) > 54% (0.54) and/or haemoglobin > 18 g/l and ongoing treatment immediately discussed with specialist.

LFTs

Action: Refer back to specialist if ALT three times greater than upper limit of normal reference range.

Lipids

Action: Full lipid screen including fasting triglycerides. Treat raised triglycerides as per local guidance.

HbA1c

Action: If diabetes or pre-diabetes.

Calcium

Action: Can possibly cause hypercalcaemia – refer to specialist if greater than upper limit of reference range.

Cervical Smear

Action: Performed according to usual screening protocols. As normal before GRS and if tissue left following GRS. Cervical-Screening-Guidance-Document-for-Primary-Care-Staff-Trans-Men-and-or-Non-Binary-People_.pdf (leedsccg.nhs.uk)

Breast Cancer Screening

Action: Performed according to usual screening protocols: Anyone who has not had bilateral mastectomy and male chest construction from the ages of 50-70 should access breast cancer screening. People who have had bilateral mastectomy surgery can also speak to their surgeon to confirm if any tissue remains, and whether future screening is needed. If the patient has not had bilateral mastectomy and male chest reconstruction and would like to take part in screening, then they can organise their mammogram by visiting their GP or booking an appointment at a screening service. If they notice any changes that are not normal for them, they should talk to their GP. Anyone taking Estradiol between the ages of 50- 70 should access breast cancer screening. If there is continued use of Estradiol then breast cancer screening should continue past 70 until Estradiol is ceased. If you are registered female with your GP you will be automatically invited to breast cancer screening.