Care Considerations for Female-to-Male Transgender Patients

Initial Assessment and Monitoring

The American College of Physicians and other medical organizations recommend establishing accurate organ inventory and preferred identity documentation in the electronic medical record before initiating care, with 28% of transgender patients reporting harassment and 2% experiencing physical abuse due to incorrect documentation 4
Documenting preferred name, pronouns, and gender identity separately from legal name and sex assigned at birth is crucial for preventing dysphoria-inducing interactions in clinical settings 4
Recording complete anatomical inventory, such as presence of uterus, ovaries, cervix, and breasts, directly impacts screening needs and treatment decisions, and should be done in accordance with guidelines from the American Medical Association 4, 5
Screening for liver abnormalities and obtaining baseline complete blood count to assess for polycythemia before initiating testosterone is recommended by the American Association for the Study of Liver Diseases 6, 7
Assessing cardiovascular risk factors, obtaining lipid profile, glucose, and baseline hormone levels is essential for comprehensive care, as recommended by the American Heart Association 7

The Endocrine Society recommends initiating testosterone cypionate or enanthate at 50 mg subcutaneously weekly, adjusting to achieve serum testosterone levels within the normal male range (300-1,000 ng/dL), with monitoring of testosterone and estradiol levels at 3 months initially, then every 3-6 months during the first year, then annually if stable 7
The American College of Clinical Endocrinologists recommends maintaining total testosterone within male physiological range (300-1,000 ng/dL) and monitoring for polycythemia with regular complete blood counts 6, 7

The American Psychiatric Association notes that testosterone therapy produces a 20% decrease in depression after 1 year and a 5.5-point increase on a 10-point quality of life scale, with no evidence of adverse mental health outcomes 9, 7
The World Professional Association for Transgender Health recommends against discontinuing testosterone due to concerns about potential regret, as this significantly worsens gender dysphoria and mental health outcomes 9, 7

The American Cancer Society recommends coordinating with surgery teams for chest masculinization and consideration of hysterectomy with bilateral oophorectomy, with continued breast cancer screening for residual breast tissue after chest surgery 8, 1, 2
The American College of Surgeons recommends surgical decisions that account for both medical necessity and gender dysphoria relief, with consideration of the patient's individual needs and preferences 8, 2

The American College of Obstetricians and Gynecologists recommends continuing cervical cancer screening if cervix remains, and breast cancer screening for residual breast tissue after chest surgery, with imaging (particularly breast MRI) to determine volume of residual breast tissue for screening decisions 8, 5

The American Medical Association recommends against using sex-assigned-at-birth reference ranges after 6 months of testosterone therapy for creatinine, body composition calculations, or chemotherapy dosing, and against requiring removal of chest binders for all procedures 8, 5, 10
The American Academy of Family Physicians recommends against mandating urine pregnancy testing without offering serum beta-hCG alternative, as this triggers significant gender dysphoria, and against assuming insurance coverage, as 19% of transgender persons lack health insurance 10, 1, 2, 3

The American College of Physicians recommends assembling a care team including primary care physician, endocrinologist, mental health professional, and surgical specialists as needed, to determine the most appropriate individualized care plan 1, 2, 3
The National Institute of Mental Health notes that comprehensive transgender health care services improve mental health, reduce suicide rates, and lower overall healthcare costs due to fewer mental health and substance abuse-related expenses 1, 2, 3