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/>
