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Majumder A, Chatterjee S, Maji D, Ghosh S, Selvan C, George B, Kalra P, Chandrasekaran S, Priya G, Sukumar S, Sanyal D, Roychaudhuri S. IDEA Group Consensus Statement on Medical Management of Adult Gender Incongruent Individuals Seeking Gender Affirmation as Male. Indian J Endocrinol Metab 2023; 27:3-16. [PMID: 37215272 PMCID: PMC10198197 DOI: 10.4103/ijem.ijem_410_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/17/2022] [Accepted: 01/06/2023] [Indexed: 03/05/2023] Open
Abstract
Gender-affirming hormone therapy (GAHT) is the most frequent treatment offered to gender-incongruent individuals, which reduces dysphoria. The goal of therapy among gender-incongruent individuals seeking gender affirmation as male is to change their secondary sex characteristics to affect masculine physical appearances. GAHT greatly improves mental health and quality of life among gender incongruent individuals. India-specific guideline for appropriate care for gender-incongruent individuals is almost absent. This document is intended to assist endocrinologists and other healthcare professionals interested in gender incongruity for individuals seeking gender affirmation as male. A safe and effective GAHT regimen aims to effect masculinising physical features without adverse effects. In this document, we offer suggestions based on an in-depth review of national and international guidelines, recently available evidence and collegial meetings with expert Indian clinicians working in this field. Clinicians represented in our expert panel have developed expertise due to the volume of gender incongruent individuals they manage. This consensus statement provides protocols for the hormone prescribing physicians relating to diagnosis, baseline evaluation and counselling, prescription planning for masculinising hormone therapy, choice of therapy, targets for monitoring masculinising hormone therapy, clinical and biochemical monitoring, recommending sex affirmation surgery and peri-operative hormone therapy. The recommendations made in this document are not rigid guidelines, and the hormone-prescribing physicians are encouraged to modify the suggested protocol to address emerging issues.
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Affiliation(s)
- Anirban Majumder
- Department of Endocrinology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Sudip Chatterjee
- Department of Medicine, Vivekanada Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Debasis Maji
- Department of Medicine, Vivekanada Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Chitra Selvan
- Department of Endocrinology, MS Ramaiah Memorial Hospital, Bengaluru, Karnataka, India
| | - Belinda George
- Department of Endocrinology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Pramila Kalra
- Department of Endocrinology, MS Ramaiah Memorial Hospital, Bengaluru, Karnataka, India
| | - Shruti Chandrasekaran
- Consultant Endocrinologist and Diabetologist, Dr. Rela Institute of Medical Center, (RIMC), Chrompet, Chennai, Tamil Nadu, India
| | - Gagan Priya
- Consultant Endocrinologist, Fortis Hospital, Mohali, Punjab, India
| | - Suja Sukumar
- Consultant Endocrinologist, Renai Medicity, Cochin, Kerala, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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Sjöström K, Mount J, Klocker A, Arthurson V. A review of adverse events in animals and children after secondary exposure to transdermal hormone-containing medicinal products. Vet Rec Open 2022; 9:e48. [PMID: 36320814 PMCID: PMC9614385 DOI: 10.1002/vro2.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
Background Hormonal replacement therapy is widely used to treat conditions in humans, the most well-known indication being the relief of menopausal symptoms in women. Many of the hormone-containing products (HCP) are applied to the skin. This transdermal delivery poses a risk to animals and humans through secondary exposure, especially when product information is not strictly followed. The aim of this article is to raise awareness among veterinarians and human healthcare providers of this risk; based on evidence from spontaneous reporting of suspected adverse events (AEs) in animals and humans. Interventions are also explored to mitigate the risk of secondary exposure to transdermal HCP (THCP). Review of spontaneously reported suspected AEs The Swedish Medical Products Agency has received several, mainly serious, AE reports in animals and children following secondary exposure to THCPs. The AE reports were reviewed together with worldwide data from the EudraVigilance Veterinary database and human EudraVigilance Data Analysis System. The clinical signs reported in animals included persistent signs of oestrus, poor growth rate and birth defects. In humans, reported clinical signs included precocious puberty, unresolved virilisation, accelerated growth rate and female infertility. Conclusions It is important that THCP are used according to manufacturer's instructions and users are made aware of risks and mitigating measures. This review of AEs in animals and children provides evidence to show that the use of THCP poses a risk for secondary exposure. Efficient communication strategies that stretch across veterinary and human medicinal disciplines are required to raise mutual awareness and minimise the risk of AEs in animals and humans.
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Affiliation(s)
- Karin Sjöström
- Veterinary Medicine GroupDepartment of Drug SafetySwedish Medical Products Agency (Läkemedelsverket)UppsalaSweden
| | - James Mount
- Veterinary Medicine GroupDepartment of Drug SafetySwedish Medical Products Agency (Läkemedelsverket)UppsalaSweden
| | - Anna‐Karin Klocker
- Veterinary Medicine GroupDepartment of Drug SafetySwedish Medical Products Agency (Läkemedelsverket)UppsalaSweden
| | - Veronica Arthurson
- Veterinary Medicine GroupDepartment of Drug SafetySwedish Medical Products Agency (Läkemedelsverket)UppsalaSweden
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Alemany M. The Roles of Androgens in Humans: Biology, Metabolic Regulation and Health. Int J Mol Sci 2022; 23:11952. [PMID: 36233256 PMCID: PMC9569951 DOI: 10.3390/ijms231911952] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Androgens are an important and diverse group of steroid hormone molecular species. They play varied functional roles, such as the control of metabolic energy fate and partition, the maintenance of skeletal and body protein and integrity and the development of brain capabilities and behavioral setup (including those factors defining maleness). In addition, androgens are the precursors of estrogens, with which they share an extensive control of the reproductive mechanisms (in both sexes). In this review, the types of androgens, their functions and signaling are tabulated and described, including some less-known functions. The close interrelationship between corticosteroids and androgens is also analyzed, centered in the adrenal cortex, together with the main feedback control systems of the hypothalamic-hypophysis-gonads axis, and its modulation by the metabolic environment, sex, age and health. Testosterone (T) is singled out because of its high synthesis rate and turnover, but also because age-related hypogonadism is a key signal for the biologically planned early obsolescence of men, and the delayed onset of a faster rate of functional losses in women after menopause. The close collaboration of T with estradiol (E2) active in the maintenance of body metabolic systems is also presented Their parallel insufficiency has been directly related to the ravages of senescence and the metabolic syndrome constellation of disorders. The clinical use of T to correct hypoandrogenism helps maintain the functionality of core metabolism, limiting excess fat deposition, sarcopenia and cognoscitive frailty (part of these effects are due to the E2 generated from T). The effectiveness of using lipophilic T esters for T replacement treatments is analyzed in depth, and the main problems derived from their application are discussed.
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Affiliation(s)
- Marià Alemany
- Facultat de Biologia, Universitat de Barcelona, Av. Diagonal, 635, 08028 Barcelona, Catalonia, Spain;
- Institut de Biomedicina, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain
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Madsen MC, den Heijer M, Pees C, Biermasz NR, Bakker LEH. Testosterone in men with hypogonadism and transgender males: a systematic review comparing three different preparations. Endocr Connect 2022; 11:e220112. [PMID: 35904217 PMCID: PMC9346330 DOI: 10.1530/ec-22-0112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
Testosterone therapy is the cornerstone in the care of men with hypogonadism and transgender males. Gel and intramuscular injections are most frequently used and are registered and included in the international guidelines. The specific preparation should be selected according to the patient's preference, cost, availability, and formulation-specific properties. As the majority of men with hypogonadism and transgender males require lifelong treatment with testosterone, it is important to utilize a regimen that is effective, safe, inexpensive, and convenient to use with optimal mimicking of the physiological situation. This systematic review reviews current literature on differences between the three most used testosterone preparations in adult men with hypogonadism and transgender males. Although it appeared hardly any comparative studies have been carried out, there are indications of differences between the preparations, for example, on the stability of testosterone levels, hematocrit, bone mineral density, and patient satisfaction. However, there are no studies on the effects of testosterone replacement on endpoints such as cardiovascular disease in relation to hematocrit or osteoporotic fractures in relation to bone mineral density. The effect of testosterone therapy on health-related quality of life is strongly underexposed in the reviewed studies, while this is a highly relevant outcome measure from a patient perspective. In conclusion, current recommendations on testosterone treatment appear to be based on data primarily from non-randomized clinical studies and observational studies. The availability of reliable comparative data between the different preparations will assist in the process of individual decision-making to choose the most suitable formula.
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Affiliation(s)
- Milou Cecilia Madsen
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin den Heijer
- Department of Internal Medicine and Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Claudia Pees
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | - Nienke R Biermasz
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Leontine E H Bakker
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Tijerina AN, Srivastava AV, Patel VR, Osterberg EC. Current use of testosterone therapy in LGBTQ populations. Int J Impot Res 2021; 34:642-648. [PMID: 34815551 DOI: 10.1038/s41443-021-00490-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 01/23/2023]
Abstract
Testosterone therapy (TT) is a type of gender-affirming hormone therapy (GAHT) in lesbian, gay, bisexual, transgender, and genderqueer (LGBTQ) populations for gender dysphoria (GD), body uneasiness, and sexual dysfunction. The physical and physiological effects of TT vary widely depending on the dosing regimen and duration of treatment. An individualized approach prioritizing patient-specific desired effects in the context of pre-existing characteristics and health history is strongly recommended. Although TT is an effective treatment for many patients, there has been an increase in the illegitimate acquisition of TT in recent years. Non-judicious prescribing and lack of physician surveillance increases the risk of unintended side effects and potential serious health consequences.
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Affiliation(s)
- A N Tijerina
- University of Texas Dell Medical School, Austin, TX, 78712, USA.
| | - A V Srivastava
- University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - V R Patel
- University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - E C Osterberg
- University of Texas Dell Medical School, Austin, TX, 78712, USA.,Dell Medical School Department of Surgery and Perioperative Care and Ascension Seton Hospital Network, Austin, TX, 78712, USA
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Al Samahy O, Othman D, Gad D, Baky Fahmy MA. Efficacy of topical testosterone in management of scrotal hypoplasia and agenesis. J Pediatr Urol 2021; 17:515.e1-515.e8. [PMID: 33678558 DOI: 10.1016/j.jpurol.2021.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/19/2021] [Accepted: 02/15/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Scrotal hypoplasia or agenesis may posses difficulty during orchidopexy or end with social anxiety around excessively small scrotal size when compared to peers, and where there may be concerns regarding the future sexual life. OBJECTIVE Any conservative modality applicable to ameliorate scrotal underdevelopment partially or completely will be useful either solely or before reconstructive surgery. STUDY DESIGN Seventeen child (3-8 years) were diagnosed with bilateral scrotal hypoplasia (SH) in 5 unilateral in 7, bilateral scrotal agenesis (SA) diagnosed in 4 cases, and unilateral in one. Testicles are either undescended, ectopic, or normal. All cases managed by Testogel 1% topical testosterone for 4 weeks. Clinical assessment by measurements of the scrotal skin surface area (scrotal length multiplied by width) and scrotal corrugations counting. Inguinal and renal ultrasound done for all cases and karyotyping for cases of agenesis and cases with bilateral undescended testicles. Total and free testosterone, LH, FSH and AMH hormones were assisted before treatment, weekly and one week after therapy. Data analyzed and evaluated, difference of means used to test for statistically significant differences between scores of scrotal development. RESULTS Free and total testosterone elevated in the 1st week of treatment, but restored to normal or higher levels in 60% of cases at the 2nd week. Satisfactory response (Increasing numbers of scrotal rugae or scrotal surface area by 30-50% above the pretreatment status) obtained in 85% and 60% of unilateral and bilateral SH, but only a partial response (10-20% increase) was gained in 40% of cases with agenesis. No major adverse effect was appreciated. DISCUSSION Response of some cases of SH to topical testosterone indicates presence of remnants of labioscrotal folds with testosterone receptors (Bell et al., 1971) [1]. Testosterone replacement therapy can improve the signs and well-being of a hypogonadal male by restoring serum testosterone concentrations to physiologic levels. In this study the mean average testosterone concentration one week after application of testogel was 13.47 ± 2.45 and 12.12 ± 2.5 within 2nd, 4th week, and after cessation of treatment. Anti-Mullerian hormone is significantly low in 12 cases; mainly in cases of SA (P-value <0.001). CONCLUSION Short term topical testosterone proved to be effective in a considerable percentage of cases of either bilateral or unilateral scrotal hypoplasia; with a subsequent increase in scrotal surface area and number of rugae, it may substitutes the indication for surgical reconstruction. Long term follow up is a limitation of this study.
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Affiliation(s)
- Omar Al Samahy
- Pediatric Surgery, Al Azhar Faculty of Medicine for Girls, Egypt
| | - Doa Othman
- Pediatric Surgery, Al Azhar Faculty of Medicine for Girls, Egypt
| | - Dalia Gad
- Pediatric Surgery, Al Azhar Faculty of Medicine for Girls, Egypt
| | - M A Baky Fahmy
- Pediatric Surgery, Al Azhar Faculty of Medicine for Girls, Egypt.
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Kintz P, Gheddar L. Le passage transcutané de l’undécylénate de boldénone peut-il être la source d’un résultat anormal lors d’un contrôle antidopage ? TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sanderson E, Abraham MB, Joseph J, Boyder C, Zhang R, Dedic D, Bell L, Kassam S, Lim EM, Choong CS. Variable persistence of serum testosterone in infants and children exposed to topical testosterone. J Paediatr Child Health 2020; 56:1464-1467. [PMID: 32100379 DOI: 10.1111/jpc.14795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Elaine Sanderson
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Mary B Abraham
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | - John Joseph
- Department of Biochemistry, PathWest Laboratory Medicine, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Conchita Boyder
- Department of Biochemistry, PathWest Laboratory Medicine, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Rui Zhang
- Department of Biochemistry, PathWest Laboratory Medicine, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Deila Dedic
- Department of Biochemistry, PathWest Laboratory Medicine, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Lana Bell
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Shalini Kassam
- Paediatric Medicines Information, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Ee Mun Lim
- Department of Biochemistry, PathWest Laboratory Medicine, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Catherine S Choong
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Australia
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Satonin DK, Ni X, Mitchell MI, Joly H, Muram D, Small DS. Amount of Testosterone on Laundered Clothing After Use of Testosterone Topical 2% Solution by Healthy Male Volunteers. J Sex Med 2016; 13:187-93. [PMID: 26803453 DOI: 10.1016/j.jsxm.2015.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/10/2015] [Accepted: 12/13/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Testosterone 2% solution (Axiron) applied to armpit(s) is used for replacement therapy in men with a deficiency of endogenous testosterone. AIM To determine the amount of testosterone on subjects' T-shirts 12 hours after applying testosterone solution, the residual testosterone on subjects' T-shirts after laundering, and the testosterone transferred to unworn textile items during laundering with worn T-shirts. METHODS Healthy males ≥18 years old applied 2 × 1.5 mL of testosterone 2% solution to both axillae (total testosterone dose: 120 mg) and dressed in cotton long-sleeved T-shirts after a ≥3-minute waiting period. T-shirts were worn 12 hours before being removed and cut into halves, after which a 10 × 10 cm sample of each armpit area was excised for testosterone quantification before or after laundering with samples of unworn textiles. MAIN OUTCOME MEASURES Testosterone on worn T-shirts before and after laundering, and on unworn textiles laundered with the worn T-shirts. RESULTS Twelve subjects enrolled and completed, with only minor adverse events. Mean testosterone in unwashed worn T-shirts was 7603 μg, with high between-subject variability (3359 μg to 13,069 μg), representing 13% of the dose to 1 armpit. Mean testosterone in worn, laundered T-shirts was 260 μg (7.55 μg to 1343 μg), representing 3% of the dose to 1 armpit. Mean transferred testosterone to other textiles during laundering ranged from 69 μg on texturized Dacron 56T Double to 10,402 μg on 87/13 nylon/Lycra knit, representing 0.0382% to 5.78% of the dose to 1 armpit. CONCLUSION Thirteen percent of the testosterone applied to axillae was transferred to T-shirts during wear. Ninety-seven percent of the transferred testosterone was removed from the T-shirts during washing, some of which was then absorbed to various degrees by other textiles. Clinical implications of these findings and biological activity of the remaining/transferred testosterone are unknown.
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Affiliation(s)
- Darlene K Satonin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
| | - Xiao Ni
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Malcolm I Mitchell
- European Clinical Pharmacology, Eli Lilly and Company, Windlesham, United Kingdom
| | - Hellen Joly
- European Clinical Pharmacology, Eli Lilly and Company, Windlesham, United Kingdom
| | - David Muram
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - David S Small
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
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