Significant proportions of TGM report desired child-bearing and many engage in receptive
vaginal intercourse with cisgender men or transgender women. Despite the frequency of desired
fertility among TGM, secondary amenorrhea and associated infertility are common in those
undergoing treatment with testosterone. Although testosterone is the mainstay of gender
affirming care in this population, the mechanism of androgen-induced menstrual suppression is
unknown due to the limited quantity of well-designed, clinical research investigating
hypothalamic-pituitary-ovarian function in testosterone-treated TGM. We hypothesize that
gender affirming testosterone therapy causes infertility in transgender men through impaired
gonadotropin secretion, altered ovarian function, or a combination of these effects. We
therefore propose to study the effect of high-dose, exogenous androgen administration on
pituitary function, ovarian folliculogenesis, and ovulatory function in transgender men.
Please note that administration of testosterone cyprionate, at a dose of 50 mg (T50) per
week, will be done at Planned Parenthood of the Pacific Southwest by Dr. Kyle Bukowski. Who
is the Associate Medical Director. In the first of our studies, in order to determine whether
normal feedback mechanisms responsible for induction of gonadotropin responses to circulating
steroid hormones are altered in TGM on testosterone, we will transiently administer steroid
hormones and measure resultant changes in gonadotropin secretion among TGM before and during
testosterone therapy, and in untreated cisgender female control subjects. In the next study,
to determine whether testosterone alters ovarian follicle function and steroidogenesis, we
will assess granulosa cell production of estradiol in response to FSH stimulation in TGM
before and during testosterone therapy.