Queer Health Resource Guide, Transmasculine Health

Androgel: Info for Trans Men

Androgel can be used to initiate or maintain the development of male secondary sex characteristics, as well as virilization (clitoral enlargement) and cessation of menstrual periods.

Though testosterone levels return to baseline 48-72 hours after last dose, most changes (such as cessation of the menstrual period and muscle/fat redistribution) reverse if Androgel treatment is stopped; however, voice changes, facial and body hair, genital growth, and male-pattern baldness persist.

Showering 2-6 hours post-dose decreases testosterone by 13%; using lotion on the application site 1 hour after increases testosterone 14%.

Excess testosterone is converted to DHT (which causes male pattern baldness) and estradiol (a form of estrogen), and can therefore cause adverse effects. This makes finding the appropriate dose and getting hormones checked regularly very important.

It is important to apply gel only to the area of your shoulders that can be covered by a t-shirt, since skin-to-skin contact within 2 hours of application can significantly increase testosterone levels in others (research shows a 280% increase in cis women with skin-to-skin contact vs. only 6% if covered with a t-shirt). Also, remember to wash your hands right away afterwards to prevent transmission as well!

You may experience an increase in urinary disorders or other side effects. It is important to continue to perform regular self chest exams to check for lumps if you still have breast tissue (including tissue near the armpits which often is not removed during top surgery). You should also get your blood pressure, red blood cell counts (to monitor for blood clots), cholesterol and T4 levels checked regularly to monitor for these side effects.


Full Review of Research Follows:

AndroGel 1.62% (Androgen. DEA CLASS CIII.)
Active ingredient:  testosterone.
Inactive ingredients:  carbopol 980, ethyl alcohol, isopropyl myristate, purified water, sodium hydroxide.

Indication and Mecanism: for adult males with testosterone deficiency, due to primary hypogonadism (cryptorchidism, bilateral torsion, orchitis, vanishing testis, orchiectomy, Klinefelter’s, toxins) or hypogonadotropic hypogonadism (gonadotropin or LH-RH deficiency or pituitary-hypothalamic injury). AndroGel produces testosterone levels (300 – 1000 ng/dL) like those of healthy cisgender men by absorbing into the skin, which serves as a reservoir for the sustained release of testosterone into the circulation. AndroGel has not been approved for age-related declines in testosterone or for men with normal testosterone levels. Transgender hormone replacement is not listed, but is a major use of this medication. May be used to initiate the maturation of male genitals (in cisgender men with the above conditions) or to initiate or maintain the development of male secondary sex characteristics (in cisgender or transgender men), as well as for clitoral enlargement and the cessation or menstrual periods in trans men. In trans men, most changes reverse if Androgel treatment is stopped, but voice changes, facial and body hair, genital growth, and male-pattern baldness persist.

PK/PD: Circulating testosterone is bound to sex hormone-binding globulin (40%), as well as albumin and other plasma proteins (58%), while 2% remains unbound. It is metabolized into active metabolites estradiol and DHT, therefore excess testosterone (converted to estradiol) can counteract desired effects. Elimination via urine (90%) and feces (6%); T1/2=10-100 min. Testosterone levels return to baseline 48-72 hours after last dose. Showering 2-6 hours post-dose decreases testosterone by 13%; 10 hours after has no effect. Using lotion 1 hour after increases testosterone 14%.

Containdications and Warnings: Pregnancy Category X, not for use in nursing. BOXED WARNING: Virilization in children secondarily exposed (enlarged genitals, early pubic hair, erections, aggression, advanced bone age). Skin-to-skin contact 2 hours after application increases testosterone in adult females by 280%, while contact with a clothed application site increases testosterone only 6%.

Dosage Instructions: Starting dose of 40.5 mg (2 full pumps) applied topically each morning after bathing. It is necessary to prime the pump before FIRST use by depressing the actuator three times and washing this gel down the sink. Apply to shoulders, let dry completely, and cover with a shirt. Wash hands right away. Apply a missed dose as soon as possible, but never apply a double dose. Dose should be modified based on the pre-dose testosterone concentration at 14 days and 28 days and periodically thereafter: if more than 750 nd/dL decrease by 1 pump, if less than 350 ng/dl increase by 1 pump.

Adverse Reactions: The most common (11.1% of subjects) is an increase in prostate specific antigen, which may worsen benign prostatic hyperplasia. Others include: prostate or breast cancer; decreased spermatogenesis and libido; gynecomastia; urinary disorders; increased erections; polycythemia (increased RBC) and associated thromboembolic events (stroke, heart attack, blood clots); edema or CHF with preexisting cardiac, renal, or hepatic disease; changes in serum lipid profile; hypertension; asthenia; decreased thyroxin-binding globulins and T4, and increased T3 and T4 uptake; headache; mood changes; sleep apnea; acne; skin reaction or color change; teary or yellow eyes; itchy skin; extremity pain, swelling or redness; shortness of breath; vomiting, diarrhea; sinusitis.

Drug-drug/herb Interactions: May decrease insulin requirements in diabetics. May change anticoagulant activity. Adrenocorticotropic hormone or corticosteroids may increase fluid retention.

References:
“Androgel.” PDR.net (n.d). 23 November. 2014. <http://www.pdr.net/drug-summary/androgel-162?druglabelid=5&id=1123&gt;
“Testosterone Topical.” Medline Plus (n.d.). 23 November. 2014. <http://www.nlm.nih.gov/medlineplus/druginfo/meds/a605020.html&gt;
Maddox. “Tip #25: Intro to Testosterone HRT.” Tips for Trans Men (24 August. 2012). 26 November. 2014. <http://tipsfortransmen.com/2012/05/09/tip-seriesandrogel-injection-alternatives/&gt;


All advice on this site and blog is for educational uses only. Always consult your doctor before taking any herbs or supplements, or schedule an acupuncture appointment with Katrina to get your own personalized herbal formula and acupuncture treatment. Questions? Check out the FAQ or resources pages or leave a comment below.

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