Adjusting Doses
When to Adjust
| Situation | Action |
|---|---|
| T < 300 ng/dL (trough) | Increase dose |
| T 300–1,000 ng/dL | Maintain |
| T > 1,000 ng/dL (trough) | Consider reducing dose |
| HCT > 54% | Reduce dose or phlebotomy |
| Side effects intolerable | Reduce dose or change form |
Adjustment Guidelines
| Current Dose | Adjustment |
|---|---|
| T cypionate 50 mg/week | Increase to 60–75 mg/week |
| T cypionate 75 mg/week | Increase to 100 mg/week |
| T gel 25 mg/day | Increase to 50 mg/day |
| T gel 50 mg/day | Increase to 75–100 mg/day |
Changing Injection Frequency
| Frequency | Pros | Cons |
|---|---|---|
| Weekly | More stable levels | More injections |
| Every 2 weeks | Fewer injections | Greater peak-to-trough swing |
Special Considerations
- Aromatisation: High T may convert to E2; consider aromatase inhibitor if E2 > 100 pg/mL
- SHBG: Low SHBG means more free T at the same total T; may need lower dose
- HCT: If rising, reduce dose or donate blood
References
UCSF Transgender Care. Masculinising hormone therapy — dose adjustments. https://transcare.ucsf.edu/guidelines
Hembree WC, et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. JCEM, 102(11):3869–3903. https://academic.oup.com/jcem/article/102/11/3869/4157558
Coleman E, et al. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(S1). https://www.tandfonline.com/doi/full/10.1080/26895269.2022.2100644