Prior to treatment

Before you begin your treatment, you will need to have the following tests and examinations done:

• Blood tests to ensure that your kidneys, liver, and metabolism are functioning normally. We also measure the level of triglycerides, as well as male and female hormones in your blood
• A physical examination includes measuring your height, weight, and blood pressure, and sometimes we also listen to your heart and lungs with a stethoscope
• Possibly also a gynaecological examination and an ultrasound scanning of the pelvis. 
   

Hormone therapy

In by far the majority of cases, we recommend that you start your male hormone therapy treatment with a transdermal gel.

Testosterone gel

In by far the majority of cases, we recommend that you start your male hormone therapy treatment with a transdermal gel.

Testosterone gel 

The gel contains the male hormone testosterone. Apply daily to clean and dry skin on your shoulders, thighs or stomach. Do not apply the gel to the genital area. Be aware that you risk transferring testosterone to others upon close skin contact. Read the patient information leaflet carefully before use.

Nebido (testosterone)

Nebido is a long-acting injectable testosterone therapy. Nebido is administered as an intramuscular injection once every 12 weeks (however, only six weeks should pass from the first to the second injection). Your general practitioner will administer the injections.  Injections should be given, and blood tests should be taken at the intervals stated in the schedule you will receive when your treatment begins. After the first year, you should have a check-up once every one or two years.

It is important that you get a blood test done before you come in for these check-ups, so we can review the results together and adjust your treatment if necessary.
 

Check-ups

Prior every check-up, it is important that you get a blood test done 1-2 weeks before your check-up appointment, so we can review the results together and adjust your treatment if necessary.

It is important that you do not apply any gel to the arm from which your blood sample will be drawn 2-3 days before the blood test is taken as this may affect your test results.

If you have any questions about your hormone therapy, we recommend that you write them down and bring them with you to the appointment.
 

During the first year 

Your first check-up will be after three months of treatment. We will inform you about the results of the blood test over the phone. After six months and 12 months of treatment, we will check your hormone levels again. 

If we have found the correct testosterone dose for you and you are responding well to the treatment, we will decide whether you should switch to a long-acting (depot) injectable instead.
 

Check-ups beyond one year

After the first year, you will need to come in for a check-up once every one or two years.

In some cases, your general practitioner or medical specialist can take over these check-ups.
 

If you are already receiving hormone therapy with male sex hormones

If you are already receiving hormone therapy with male sex hormones prescribed by a physician when you are referred to CKI, we will assess your situation based on blood tests and a physical examination. The objective of this is to assess whether we can proceed with your treatment, or whether we need to make some adjustments to ensure a healthy balance between the desired effects and any side effects.

What changes can you expect during your treatment?

You can expect that:

• You will stop menstruating. Typically, this will happen within the first 1-4 months. 
• However, some individuals continue to menstruate. This may be due to too low a dose of testosterone, but sometimes it is also seen at regular testosterone levels. If this is the case, you may need to temporarily supplement your treatment with gestagen
• You will gradually develop male hair growth patterns such as facial hair (beard) and hair on your chest, arms, and legs.
• Your voice will become deeper
• Your clitoris will become slightly enlarged
• Your sex drive may increase in the first few months, but this effect will gradually subside

Most of these changes will happen gradually, and it can take several years before you see the full effect.
 

What are the side effects of the treatment?

The treatment has several side effects, which you need to know about. Therefore, you need to come in for regular check-ups at the beginning of your treatment.

• Red and irritated skin caused by gel treatment
• Bodily fluid retention
• Abnormal uterine bleeding
• Vaginal discomfort such as dryness, itching and burning. Can be alleviated with local hormone therapy
• Excess sweating and changed body odor
• Elevated hemoglobin count (doping)
• Muscle and joint pain
• If your dose is too high, there is a risk of venous thrombosis
• Increased sex drive
• Mood swings. Some people become more short-tempered and angrier
• Slightly increased risk of cardiovascular disease, i.e., high blood pressure and risk of coronary thrombosis
• Effect on kidney function
• Effect on liver function
• Weight gain
•  Acne
• Hair loss

Birth control

Even though treatment with testosterone in most cases will prevent ovulation, this is no guarantee that you will not get pregnant. If you have vaginally penetrative sex with a man, you should consider using contraception such as an intrauterine device (IUD) that does not contain hormones.

Prescriptions

We generally ensure that you have the prescriptions you need until you come in for your next check-up. However, if you run out of medicine because you have rescheduled your appointment, you must remember to contact us in good time. Sometimes you will have to wait 2-3 weeks for a prescription renewal.

Reimbursement of medicine costs

You must pay for the gel and injections yourself, but we will apply for single reimbursement so that you are reimbursed according to the standard rules for reimbursement once your medicine costs exceed a certain amount. When you switch from gel to injection you will have to contact the Lægemiddelstyrelsen yourself to change your approval for reimbursement. Read more at: laegemiddelstyrelsen.dk

Abnormal cervical cells

You should be aware that if you change your civil registration number (CPR number), you will no longer automatically be invited to cervical screening tests (Pap smear). You must remember to have a Pap smear done once every third year until you turn 50.

Gender reassignment surgery

If you decide to have your ovaries removed at a later point, you must continue your hormone therapy as this will be your only source of sex hormones. You need sex hormones to ensure your body functions normally and to prevent osteoporosis.

Once you have had your ovaries removed, you can no longer have children with your own eggs. Currently, the public healthcare system does not offer to store eggs intended for later use.

Research at the Centre for Gender Identity

The Centre for Gender Identity is involved in various research projects. You may be asked to participate in a project. You will always receive detailed information about the specific project. 
 
We want you and others to have a positive experience at the Centre for Gender Identity. We therefore continuously evaluate patient satisfaction to improve it. We are aware that there is always something that can be done differently and better.  
 
To better understand our patients’ perspectives on some of our initiatives, we have established a patient group of user representatives. For example, the group provides us with input on written information for patients.
 
One of our current projects is the Cohort of Gender Identity.