Endocrine Abstracts

Forty-four-year-old transgender – female to male who underwent surgery for gender reassignment including hysterectomy, oophrectomy and mastectomy.

He has been on testosterone replacement since 2003, initially oral, then sustanon 250 mg IM injection 2 weekly which was self-administered. He was keen on long-acting testosterone injections (Nebido) so was referred to our endocrine service, as his GP was reluctant to prescribe testosterone replacement, as it is unlicensed in transgender patients. I administered this drug, as the surgery would not allow their nurse to carry out the treatment. Nebido is not suitable for self-injection.

Baseline bloods – LH, FSH, testosterone SHBG, cholesterol ratio, glucose, FBC were carried out in January 2008. Initial haemoglobin (Hb) was found to be 18.6 g/dl (13.5–18.0 NR – male). Packed cell volume (PCV) was also noted to be at the high end of the male range. This is possibly related to 2 weekly sustanon injections.

During Nebido treatment work up the patient’s Hb’s lowest point was 18.0 g/dl and PCV was 0.55 (NR – male 0.40–0.52). At the time of the 4th Nebido injection, Hb was noted to be at its highest 19.4 g/dl and PCV 0.57 carrying a greater risk of thrombosis. The patient is fully aware of the risks and was informed about this.

It was noted that over the last 12-week period the patient’s testosterone levels at week 9 was 15.5 nmol/l and increased to 22.6 nmol/l (NR – male 8.0–30.0) at week 12 which was on the day that his Nebido injection was administered.

Should this patient’s FBC levels be checked against the male or female range as from a genetic fingerprint, this patient is female. If this is the case there is an even greater risk of thrombosis as the female range for Hb is 11.5–16.0 g/dl.