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Type: Journal article
Title: Prevalence of polycythaemia with different formulations of testosterone therapy in transmasculine individuals
Author: Nolan, B.J.
Leemaqz, S.Y.
Ooi, O.
Cundill, P.
Silberstein, N.
Locke, P.
Grossmann, M.
Zajac, J.D.
Cheung, A.S.
Citation: Internal Medicine Journal, 2021; 51(6):873-878
Publisher: Wiley
Issue Date: 2021
ISSN: 1444-0903
Statement of
Brendan J. Nolan, Shalem Y. Leemaqz, Olivia Ooi, Pauline Cundill, Nicholas Silberstein, Peter Locke, Mathis Grossmann, Jeffrey D. Zajac and Ada S. Cheung
Abstract: Background: Masculinising hormone therapy with testosterone is used to align an individual's physical characteristics with their gender identity. Testosterone therapy is typically administered via intramuscular or transdermal routes and polycythaemia is the most common adverse event. Aims: To compare the risk of polycythaemia with different formulations of testosterone therapy in transmasculine individuals. Methods: A retrospective cross-sectional analysis was undertaken of transmasculine individuals at a primary and secondary care clinic in Melbourne, Australia. 180 individuals who were on testosterone therapy for >6 months were included. Groups included those receiving (1) intramuscular testosterone undecanoate (n = 125), (2) intramuscular testosterone enantate (n = 31), or (3) transdermal testosterone (n = 24). Outcome was prevalence of polycythaemia (defined as haematocrit >0.5). Results: Mean age was 28.4 (8.8) years with a median duration of testosterone therapy 37.7 (24.2) months. 27% were smokers. There was no difference between groups in serum total testosterone concentration measured. Whilst there was no difference between groups in haematocrit, there was a higher proportion of patients with polycythemia in those who were on intramuscular testosterone enantate (23.3%) than on transdermal testosterone (0%), p = 0.040. There was no statistically significant difference in polycythaemia between intramuscular testosterone undecanoate (15%) and transdermal, p = 0.066 nor between intramuscular testosterone enantate and undecanoate, p = 0.275. Conclusions: One in four individuals treated with intramuscular testosterone enantate and one in six treated with testosterone undecanoate had polycythaemia. No individual treated with transdermal testosterone had polycythaemia. This highlights the importance of regular monitoring of haematocrit in transmasculine individuals treated with testosterone and findings may inform treatment choices
Keywords: Transgender; testosterone; polycythaemia; haematocrit
Rights: © 2020 Royal Australasian College of Physicians
RMID: 1000020466
DOI: 10.1111/imj.14839
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