26 years healthy transgender male without any medical history came to see you for cross-sex hormone therapy.
Testosterone IM injection 50 mg weekly was initiated. Follow up lab result 4 months after initiation of Testosterone therapy; Total Testosterone level 350 ng/dL ( normal value 250-1100 ng/dL) and Estradiol level 50 pg/mL ( normal value for male <31 pg/mL) , CBC, chemistry panel and liver function test were normal. Patient noticed development of mild facial hair and amenorrhea after 5 months of Testosterone therapy. After 8 months of testosterone therapy, patient called your office for the complaint of recurrence of menstrual cycle (mostly spotting) and abdominal cramping. He was concerned that hormone therapy became less effective and wanted to discuss about other treatment option.