Target Trough Testosterone Levels for Trans Men

Recommended Target Levels and Monitoring

The American College of Physicians recommends that the target trough testosterone level for trans men should be maintained within the typical physiological range for cisgender men of 300-1,000 ng/dL 1, 2, 3
The commonly recommended hormone therapy for transmasculine people aims to bring testosterone levels into the typical physiological range for cisgender men (300-1,000 ng/dL) 1, 3
Trough levels should be measured at the appropriate time based on the testosterone formulation used (typically right before the next scheduled dose) 4

Testosterone regimens for trans men consist of several options, including injectable esters, gels, and patches (transdermal), with injectable esters being the most commonly used 1
The Endocrine Society recommends using testosterone undecanoate (long-acting testosterone) with caution, as it raises concerns of pulmonary oil microembolism and anaphylaxis 1

Desired effects of testosterone therapy include lowered voice pitch 1
Increased lean muscle mass and strength is a common effect of testosterone therapy 3
Increased libido is also a common effect of testosterone therapy 1

Regular monitoring should include hematocrit/hemoglobin, as testosterone therapy commonly causes erythrocytosis, particularly with injectable formulations 4
If hematocrit rises above the reference range, consider temporarily withholding therapy, reducing the dose, or performing phlebotomy 4
Lipid profiles should be monitored, as testosterone may increase triglycerides and LDL cholesterol while decreasing HDL 1
Blood pressure should be monitored, as testosterone may increase blood pressure 1

Inadequate dosing of testosterone may have a negative impact on bone density in trans men 3
Risk of erythrocytosis can be reduced through smoking cessation, weight loss, and switching to a transdermal route of administration 1
Current evidence suggests little to no impact on cardiovascular outcomes in trans men 1

Dose should be adjusted based on serum testosterone levels, aiming for the mid-normal range 4