More evidence testosterone safe for gender-affirming care

An Australian study published in the International Journal of Transgender Health has highlighted the safety profile of testosterone when used for gender-affirming hormone treatment (GAHT).  
 
The observational study used data from nearly 300 patients attending nine GP clinics across five cities where testosterone was prescribed for GAHT. As a comparison, data was also collected from over 200 cisgendered men who were receiving the hormone to treat testosterone deficiency.
 
Self-reported side effects alongside multiple health monitoring tests, including blood pressure, liver function and cholesterol levels, were analysed. No significant difference in the rates of adverse events was found between the two groups.
 
Melbourne-based lead researcher and GP Dr Beng Eu told newsGP that the findings of the study are encouraging and GPs should feel confident providing testosterone for GAHT, adding that the reported side-effects are manageable.
 
‘GAHT with testosterone can be implemented in general practice as we did not find any increased measured adverse events in this population,’ he said.
 
‘In fact, the adverse events rate was similar or lower than when we use [testosterone] for testosterone deficiency. The only reported adverse events that were significant and reported in this younger age group was acne and balding, which GPs treat regularly.’
 
Although the findings were in keeping with other studies that have demonstrated the safety of testosterone use for GAHT, the rates of smoking and mental health comorbidities were not anticipated.
 
‘The findings were both expected and unexpected,’ Dr Eu said.
 
‘We did not expect to see any additional adverse events of concern, but noted that the smoking rates were higher than population average and the underlying depression/anxiety was high.
 
‘It might be worth considering asking [patients treated with testosterone] about acne and balding as well as mental health issues and smoking.’
 
Testosterone prescribing for GAHT in Australia is increasing, and the number of GP prescribers is expected to rise with improved awareness and understanding of informed consent standards of care for GAHT. However, prescriber autonomy in general practice remains limited largely due to PBS requirements.
 
Dr Michelle Dutton, Chair of RACGP Specific Interests Transgender and Gender-Diverse Healthcare, told newsGP that testosterone is safe for GPs to prescribe and unnecessary barriers for patients who are seeking GAHT should be removed.
 
‘These study findings add to the increasing body of evidence showing the safety and effectiveness and indeed importance of gender-affirming hormone therapies,’ she said.
 
‘GPs have a very diverse range of skillsets and are very much capable of initiating and monitoring testosterone therapy for gender affirmation. They should absolutely feel confident and supported to do so within their scope as a specialist GP.
 
‘As with all treatments, this should be in the context of having had clear discussions with the patient about effects, side effects and risks, obtaining informed consent and planning treatment collaboratively.’
 
However, Dr Dutton identified the current PBS requirement for testosterone therapy to involve a non-GP specialist such as an endocrinologist, sexual health physician or urologist in all cases as a ‘major challenge’.
 
‘This creates a significant barrier to affordable therapy for many patients,’ she said.
 
‘The decision as to whether to involve a non-GP specialist should rest with the prescribing GP and their patient, as with almost all other safe and effective treatments that we provide.’
 
When providing treatment with testosterone in the context of GAHT, Dr Eu says that GPs can, if needed, seek further education and training to support their transgender and gender-diverse patients.
 
‘We understand that the decision to commence testosterone requires some thought and additional education if appropriate, but this should not prevent GPs continuing on managing patients on testosterone for GAHT,’ he said.
 
‘There is training available run by Thorne Harbour Health, done either by webinar over a few nights or on a weekend which can help a GP understand transgender health a bit better.’
 
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