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Abstract

Context:

Testosterone (T) is commonly administered intramuscularly to treat hypogonadal males and female-to-male (FTM) transgender patients. However, these injections can involve significant discomfort and may require arrangements for administration by others.

Objective:

We assessed whether T could be administered effectively and safely subcutaneously as an alternative to intramuscular (IM) injections.

Design:

Retrospective cohort study.

Setting:

Outpatient reproductive endocrinology clinic at an academic medical center.

Patients:

Sixty-three FTM transgender patients aged >18 years electing to receive subcutaneous (SC) T therapy for sex transition were included. Fifty-three patients were premenopausal.

Intervention:

Patients were administered T cypionate or enanthate weekly at an initial dose of 50 mg. Dose was adjusted if needed to achieve serum total T levels within the normal male range.

Main Outcome Measurements:

Serum concentrations of free and total T and total estradiol (E2), masculinization, and surveillance for reactions at injection sites.

Results:

Serum T levels within the normal male range were achieved in all 63 patients with doses of 50 to 150 mg (median, 75/80 mg). Therapy was effective across a wide range of body mass index (19.0 to 49.9 kg/m 2 ). Minor and transient local reactions were reported in 9 out of 63 patients. Among 53 premenopausal patients, 51 achieved amenorrhea and 35 achieved serum E2 concentrations <50 pg/mL. Twenty-two patients were originally receiving IM and switched to SC therapy. All 22 had a mild (n = 2) or marked (n = 20) preference for SC injections; none preferred IM injections.

Conclusions:

Our observations indicate that SC T injections are an effective, safe, and well-accepted alternative to IM T injections.

Issue Section:

Testosterone (T) therapy is commonly administered to hypogonadal men and female-to-male (FTM) transgender patients. Since its introduction in the 1930s, parenteral T has typically been administered intramuscularly ( 1 , 2 ). However, intramuscular (IM) administration of T has drawbacks such as pain, bruising, and the frequent necessity to arrange injections by a medical provider or other person. T undeconoate provides an option for IM injections at 10-week intervals but is available only through a risk evaluation and mitigation program because of the risk of pulmonary oil microembolism ( 3 5 ). Transdermal T formulations (patches and gels) can also have limitations such as local reactions, poor adhesion, fear of skin-to-skin transmission ( 6 ), unpleasant odor ( 7 ), lack of insurance coverage or high copays, and limited patient acceptance ( 8 ). Subcutaneous (SC) insertion of T pellets is available but has been limited by the need for surgery, the possibility of infection, fibrosis or pellet extrusion, limited data regarding efficacy, inflexibility of dosing, and limited acceptance ( 9 ).

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. Kilbury, who had been working on brand Heineken, took the Dos Equis role in September. He had previously worked with Droga5 on the "No Bollocks" campaign for Heineken-owned Newcastle Brown Ale, which drew attention for its funny ribbing of conventional beer-selling ploys.

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Figure 4

Time course of (a) mprA-gfp and (b) sigE-gfp expression . harboring the appropriate promoter construct was grown for different periods of time (indicated in hours (h)) and the specific promoter-driven expression of GFP was monitored by flow cytometry. With time, there is a gradual transition from the L to the H subpopulation.

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Figure 5

Fitting of data with two distributions . Experimental data for cell count versus GFP fluorescence intensity at selected time points when is fused with and promoters respectively. The solid curve represents (, ) in equation ( 5 ) and the dotted curves are the individual terms on the r.h.s.

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Figure 6

Analysis of the time course of gfp expression . (a) Mean protein level in L subpopulation (basal level) versus time in hours in the three cases of fused with , and promoters respectively. (b) Fraction of cells (t) in the H subpopulation versus time in hours in the three cases. (c) Transition rate from the L to the H subpopulation and the CV (experimental data shown) of the protein levels in the L subpopulation versus time in hours in the three cases. The experimental data are analyzed using the binning algorithm to obtain the plots (a), (b) and (c).

Figure S4 (Additional File Calvin Klein Woman Leopardprint Lowrise Briefs Offwhite Size M Calvin Klein Newest Online Clearance Free Shipping Cheap Sale Really nQhp2wr
) shows the plots of mean GFP fluorescence level for the total population versus time in the three cases of gfp fused with the promoters of mprA , sigE and rel respectively. As in the case of the basal level versus time data (Figure 6(a) ), the plots are sigmoidal in nature. We solved the differential equations of the theoretical model described in Additional File Outlet 100% Original Buy Cheap Excellent DESIGN TALL tshirt with roll sleeves in white White Asos Outlet With Paypal Free Shipping Huge Surprise 2R47T5M
and obtained the concentrations of MprA, MprB, SigE, MprA-P, MprB-P and GFP versus time. Some of these plots are shown in Figure S5 (Additional File Outlet Hot Sale Exclusive Womens Generous Invisible SG Moulé Classic Bra Plain Everyday Bra Dim Wide Range Of Cheap Fake Outlet Latest N49qQVjh
) and reproduce the sigmoidal nature of the experimental plots. We note that the sigmoidal nature of the curves is obtained only when the non-linear nature of the degradation rate is taken into account.

As we have already discussed, the distribution of GFP levels in the mycobacterial cell population is a linear combination of two invariant distributions, one Gaussian and the other lognormal, with only the coefficients in the linear combination dependent on time. Friedman et al. [ 43 ] have developed an analytical framework of stochastic gene expression and shown that the steady state distribution of protein levels is given by the gamma distribution. The theory was later extended to include the cases of transcriptional autoregulation as well as noise propagation in a simple genetic network. While experimental support for gamma distribution has been obtained earlier [ Womens Swimsuit Sunflair Outlet With Paypal 2018 Online For Sale 2018 Wholesale Price For Sale Sast For Sale izc8e5B2M
], a recent exhaustive study [ 45 ] of the E. coli proteome and transcriptome with single-molecule sensitivity in single cells has established that the distributions of almost all the protein levels out of the 1018 proteins investigated, are well fitted by the gamma distribution in the steady state. The gamma distribution was found to give a better fit than the lognormal distribution for proteins with low expression levels and almost similar fits for proteins with high expression levels. We analysed our GFP expression data to compare the fits using lognormal and gamma distributions. For all the three sets of data ( gfp fused with the promoters of mprA , sigE and rel ), the lognormal and gamma distribution give similar fits at the different time points. Figure S6 (Additional File 1 ) shows a comparison of the fits for the case of gfp - mprA . The lognormal appears to give a somewhat better fit than the gamma distribution, specially at the tail ends.

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