Transgender Health clinical trials at UCSD
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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.