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Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT06450405
Other study ID # 808679
Secondary ID 1R01HD111650-01
Status Not yet recruiting
Phase
First received
Last updated
Start date June 1, 2024
Est. completion date June 1, 2029

Study information

Verified date June 2024
Source University of California, San Diego
Contact Antoni Duleba, MD
Phone 619-804-4765
Email aduleba@health.ucsd.edu
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

This research study investigates whether male-level exogenous androgens inhibit the reproductive neuroendocrine axis in otherwise healthy (non-PCOS) females.


Description:

Testosterone Replacement Therapy (TRT) is the mainstay of gender affirming care for transgender men (TGM) who have male gender identity after female sex assignment at birth. TGM receiving TRT over time exhibit irregular menstrual bleeding, however, the mechanism of menstrual disruption is unknown. Therefore, the investigators propose to evaluate the effect of chronic testosterone (T) exposure on ovarian hormones and pituitary gonadotropin release that determines menstrual cyclicity. The investigators will conduct a detailed study of urinary and blood reproductive hormone secretion in TGM before and during TRT as well as in untreated cisgender female (CGF) control subjects who report female gender identity congruent with female sex assignment at birth. The investigators will also perform periodic clinical and ultrasonographic evaluations. Furthermore, the investigators will monitor menstrual cycles and reproductive hormones in TGM who make the personal decision to discontinue TRT, whether it is to pursue fertility or for other reasons.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 80
Est. completion date June 1, 2029
Est. primary completion date June 1, 2028
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Female
Age group 18 Years to 35 Years
Eligibility Inclusion Criteria: All 1. Provision of signed and dated informed consent form 2. Stated willingness to comply with all study procedures and availability for the duration of the study 3. Aged 18-35 Transgender/Non-binary Group - Initiators 4. Plan to initiate testosterone therapy 5. History of regular menstrual cycles (every 24-35 days) at baseline, before beginning TRT Transgender/Non-binary Group - Discontinuers 4. Plan to discontinue testosterone therapy 5. History of regular menstrual cycles (every 24-35 days) before beginning TRT Cisgender Female Group 4. Having regular menstrual cycles (every 24-35 days) Exclusion Criteria: All 1. Pregnant 2. Incarcerated 3. Known cognitive impairment or institutionalized 4. Hemoglobin less than 11 gm/dl at screening evaluation 5. Weight less than 110 pounds 6. BMI <18 or >35 7. Current endocrine disease- including untreated thyroid abnormalities, pituitary or adrenal disease, polycystic ovary syndrome, or androgen producing tumor 8. Current or recent pregnancy within two months of study enrollment 9. Current or recent breast feeding within two months of study enrollment 10. Diabetes, or renal, liver, or heart disease 11. History of oophorectomy or hysterectomy 12. History of radiation or surgery involving brain structures 13. Currently taking any medications that may affect their reproductive hormones, such as contraceptive medications, androgens, estrogens, progestins, GnRH antagonists, GnRH agonists, insulinomimetics, and metformin. For TRT Initiation Group and Cisgender Female group: 14. History of prior testosterone therapy

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Testosterone Cypionate 50 MG/ML Injectable Solution
Participants in the initiating group will receive weekly doses of testosterone for gender-affirming care. Participants in the discontinuing group will receive testosterone during their first month of enrollment and then will cease receiving testosterone. Participants in the discontinuing group will receive testosterone during their first month of enrollment and then will cease receiving testosterone.

Locations

Country Name City State
United States University of California San Diego San Diego California

Sponsors (3)

Lead Sponsor Collaborator
University of California, San Diego Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)

Country where clinical trial is conducted

United States, 

References & Publications (35)

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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrian TM, Allen LR, Azul D, Bagga H, Basar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitan L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022 Sep 6;23(Suppl 1):S1-S259. doi: 10.1080/26895269.2022.2100644. eCollection 2022. — View Citation

Conron KJ, Scott G, Stowell GS, Landers SJ. Transgender health in Massachusetts: results from a household probability sample of adults. Am J Public Health. 2012 Jan;102(1):118-22. doi: 10.2105/AJPH.2011.300315. Epub 2011 Nov 28. — View Citation

De Cuypere G, Van Hemelrijck M, Michel A, Carael B, Heylens G, Rubens R, Hoebeke P, Monstrey S. Prevalence and demography of transsexualism in Belgium. Eur Psychiatry. 2007 Apr;22(3):137-41. doi: 10.1016/j.eurpsy.2006.10.002. Epub 2006 Dec 26. — View Citation

Deutsch MB, Bhakri V, Kubicek K. Effects of cross-sex hormone treatment on transgender women and men. Obstet Gynecol. 2015 Mar;125(3):605-610. doi: 10.1097/AOG.0000000000000692. — View Citation

Dewis P, Newman M, Ratcliffe WA, Anderson DC. Does testosterone affect the normal menstrual cycle? Clin Endocrinol (Oxf). 1986 May;24(5):515-21. doi: 10.1111/j.1365-2265.1986.tb03280.x. — View Citation

Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017 Nov 1;102(11):3869-3903. doi: 10.1210/jc.2017-01658. Erratum In: J Clin Endocrinol Metab. 2018 Feb 1;103(2):699. J Clin Endocrinol Metab. 2018 Jul 1;103(7):2758-2759. — View Citation

Kassam A, Overstreet JW, Snow-Harter C, De Souza MJ, Gold EB, Lasley BL. Identification of anovulation and transient luteal function using a urinary pregnanediol-3-glucuronide ratio algorithm. Environ Health Perspect. 1996 Apr;104(4):408-13. doi: 10.1289/ehp.96104408. — View Citation

Kerman HM, Pham A, Crouch JM, Albertson K, Salehi P, Inwards-Breland DJ, Ahrens KR. Gender Diverse Youth on Fertility and Future Family: A Qualitative Analysis. J Adolesc Health. 2021 Jun;68(6):1112-1120. doi: 10.1016/j.jadohealth.2021.01.002. Epub 2021 Mar 10. — View Citation

Kuyper L, Wijsen C. Gender identities and gender dysphoria in the Netherlands. Arch Sex Behav. 2014 Feb;43(2):377-85. doi: 10.1007/s10508-013-0140-y. Epub 2013 Jul 16. — View Citation

Light A, Wang LF, Zeymo A, Gomez-Lobo V. Family planning and contraception use in transgender men. Contraception. 2018 Oct;98(4):266-269. doi: 10.1016/j.contraception.2018.06.006. Epub 2018 Jun 23. — View Citation

Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. 2014 Dec;124(6):1120-1127. doi: 10.1097/AOG.0000000000000540. — View Citation

McFarland J, Craig W, Clarke NJ, Spratt DI. Serum Testosterone Concentrations Remain Stable Between Injections in Patients Receiving Subcutaneous Testosterone. J Endocr Soc. 2017 Jul 21;1(8):1095-1103. doi: 10.1210/js.2017-00148. eCollection 2017 Aug 1. — View Citation

Meerwijk EL, Sevelius JM. Transgender Population Size in the United States: a Meta-Regression of Population-Based Probability Samples. Am J Public Health. 2017 Feb;107(2):e1-e8. doi: 10.2105/AJPH.2016.303578. — View Citation

Meyer IH, Brown TN, Herman JL, Reisner SL, Bockting WO. Demographic Characteristics and Health Status of Transgender Adults in Select US Regions: Behavioral Risk Factor Surveillance System, 2014. Am J Public Health. 2017 Apr;107(4):582-589. doi: 10.2105/AJPH.2016.303648. Epub 2017 Feb 16. — View Citation

Moravek MB, Kinnear HM, George J, Batchelor J, Shikanov A, Padmanabhan V, Randolph JF. Impact of Exogenous Testosterone on Reproduction in Transgender Men. Endocrinology. 2020 Mar 1;161(3):bqaa014. doi: 10.1210/endocr/bqaa014. — View Citation

Moseson H, Fix L, Hastings J, Stoeffler A, Lunn MR, Flentje A, Lubensky ME, Capriotti MR, Ragosta S, Forsberg H, Obedin-Maliver J. Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey. Int J Transgend Health. 2021 Nov 17;22(1-2):30-41. doi: 10.1080/26895269.2020.1841058. eCollection 2021. — View Citation

Mueller A, Kiesewetter F, Binder H, Beckmann MW, Dittrich R. Long-term administration of testosterone undecanoate every 3 months for testosterone supplementation in female-to-male transsexuals. J Clin Endocrinol Metab. 2007 Sep;92(9):3470-5. doi: 10.1210/jc.2007-0746. Epub 2007 Jun 19. — View Citation

Mwamba RN, Ekwonu A, Guimaraes PVB, Raheem OA. The efficacy, safety, and outcomes of testosterone use among transgender men patients: A review of the literature. Neurourol Urodyn. 2023 Jun;42(5):921-930. doi: 10.1002/nau.25094. Epub 2022 Nov 20. — View Citation

Nakamura A, Watanabe M, Sugimoto M, Sako T, Mahmood S, Kaku H, Nasu Y, Ishii K, Nagai A, Kumon H. Dose-response analysis of testosterone replacement therapy in patients with female to male gender identity disorder. Endocr J. 2013;60(3):275-81. doi: 10.1507/endocrj.ej12-0319. Epub 2012 Oct 27. — View Citation

Pelusi C, Costantino A, Martelli V, Lambertini M, Bazzocchi A, Ponti F, Battista G, Venturoli S, Meriggiola MC. Effects of three different testosterone formulations in female-to-male transsexual persons. J Sex Med. 2014 Dec;11(12):3002-11. doi: 10.1111/jsm.12698. Epub 2014 Sep 24. — View Citation

Pfizer Inc. Depo®-Testosterone (testosterone cypionate injection, USP0 [package insert]. U.S. Food and Drug Administration website. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/085635s029lbl.pdf. Accessed May 30, 2022.

Rafferty J; COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH; COMMITTEE ON ADOLESCENCE; SECTION ON LESBIAN, GAY, BISEXUAL, AND TRANSGENDER HEALTH AND WELLNESS. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics. 2018 Oct;142(4):e20182162. doi: 10.1542/peds.2018-2162. Epub 2018 Sep 17. Erratum In: Pediatrics. 2023 Oct 1;152(4): — View Citation

Ropelato MG, Rudaz MC, Escobar ME, Bengolea SV, Calcagno ML, Veldhuis JD, Barontini M. Acute effects of testosterone infusion on the serum luteinizing hormone profile in eumenorrheic and polycystic ovary syndrome adolescents. J Clin Endocrinol Metab. 2009 Sep;94(9):3602-10. doi: 10.1210/jc.2009-0402. Epub 2009 Jun 30. — View Citation

Santoro N, Crawford SL, Allsworth JE, Gold EB, Greendale GA, Korenman S, Lasley BL, McConnell D, McGaffigan P, Midgely R, Schocken M, Sowers M, Weiss G. Assessing menstrual cycles with urinary hormone assays. Am J Physiol Endocrinol Metab. 2003 Mar;284(3):E521-30. doi: 10.1152/ajpendo.00381.2002. Epub 2002 Nov 19. — View Citation

Scheele F, Hompes PG, Gooren LJ, Spijkstra JJ, Spinder T. The effect of 6 weeks of testosterone treatment on pulsatile luteinizing hormone secretion in eugonadal female-to-male transsexuals. Fertil Steril. 1991 Mar;55(3):608-11. doi: 10.1016/s0015-0282(16)54194-6. — View Citation

Spinder T, Spijkstra JJ, Gooren LJ, Hompes PG, van Kessel H. Effects of long-term testosterone administration on gonadotropin secretion in agonadal female to male transsexuals compared with hypogonadal and normal women. J Clin Endocrinol Metab. 1989 Jan;68(1):200-7. doi: 10.1210/jcem-68-1-200. — View Citation

Spinder T, Spijkstra JJ, van den Tweel JG, Burger CW, van Kessel H, Hompes PG, Gooren LJ. The effects of long term testosterone administration on pulsatile luteinizing hormone secretion and on ovarian histology in eugonadal female to male transsexual subjects. J Clin Endocrinol Metab. 1989 Jul;69(1):151-7. doi: 10.1210/jcem-69-1-151. — View Citation

T'Sjoen G, Arcelus J, Gooren L, Klink DT, Tangpricha V. Endocrinology of Transgender Medicine. Endocr Rev. 2019 Feb 1;40(1):97-117. doi: 10.1210/er.2018-00011. — View Citation

Taub RL, Ellis SA, Neal-Perry G, Magaret AS, Prager SW, Micks EA. The effect of testosterone on ovulatory function in transmasculine individuals. Am J Obstet Gynecol. 2020 Aug;223(2):229.e1-229.e8. doi: 10.1016/j.ajog.2020.01.059. Epub 2020 Feb 8. — View Citation

Van Caenegem E, Wierckx K, Elaut E, Buysse A, Dewaele A, Van Nieuwerburgh F, De Cuypere G, T'Sjoen G. Prevalence of Gender Nonconformity in Flanders, Belgium. Arch Sex Behav. 2015 Jul;44(5):1281-7. doi: 10.1007/s10508-014-0452-6. Epub 2015 Jan 15. — View Citation

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* Note: There are 35 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Evidence of Luteal Activity (ELA) Evidence of Luteal Activity (ELA), as defined by a 3-fold increase in urinary pregnanediol glucuronide (PdG) level over baseline. Basal urinary PdG levels, normalized to urinary creatinine excretion, will be determined based upon the minimum daily PdG level detected per cycle or 4-wk interval. PdG will be measured via enzyme-linked immunosorbent assay (ELISA). Through study completion, an average of 7 months.
Primary Determination of pulsatile LH secretion Subjects will have baseline measurement of serum LH immediately followed by frequent blood sampling at 10-min intervals for 8 h. We will measure LH pulse frequency, the number of LH pulses per 8 hours. Through study completion, an average of 7 months.
Primary Uterine bleeding pattern. All subjects will complete a daily uterine bleeding log using REDCap® Through study completion, an average of 7 months.
Secondary Determination of gonadotropin levels Measurement of of serum FSH and LH levels, in IU/mL Through study completion, an average of 7 months.
Secondary Determination of serum FSH, AMH and testosterone During testing of LH pulses (Primary outcome 2), FSH, AMH and testosterone levels will be measured hourly. Through study completion, an average of 7 months.
Secondary Determination of ovarian/uterine morphology: Presence of corpus luteum TGN will undergo weekly ultrasound (US) following TRT initiation for confirmation of corpus lutes (CL) formation (Yes/No). Through study completion, an average of 7 months.
Secondary Determination of ovarian/uterine morphology: Thickness of endometrium TGN will undergo weekly ultrasound (US) following TRT initiation to measure endometrial thickness (mm). Through study completion, an average of 7 months.
Secondary Determination of ovarian/uterine morphology: Ovarian astral follicle count. TGN will undergo weekly ultrasound (US) following TRT initiation to measure astral follicle count (AFC). Through study completion, an average of 7 months.
Secondary Determination of ovarian/uterine morphology: volume of uterus and ovaries TGN will undergo weekly ultrasound (US) following TRT initiation to measure volume of uterus and ovaries (mL). Through study completion, an average of 7 months.
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