Q: Why am I not experiencing significant masculinisation despite being on testosterone replacement therapy?

A: The process of masculinisation through testosterone therapy can be influenced by several factors, and the response to therapy can vary widely among individuals.

1. Role of Testosterone in Masculinisation:

• Testosterone is one of the primary sex hormone responsible for developing secondary sexual characteristics. It induces increased muscle mass, deeper voice, facial and body hair growth, and changes in body fat distribution.
• Masculinisation refers to the development of these characteristics, and testosterone aims to induce these changes in individuals who are deficient in natural testosterone production.

2. Factors Affecting Response to Testosterone Therapy:

• Genetic Factors: While chromosomes themselves don’t directly dictate the response to testosterone, genetic variations can influence how the body processes and responds to the hormone.
• Androgen Sensitivity: This refers to how effectively the body’s cells respond to testosterone. Androgen insensitivity syndrome (AIS) is a condition where the body’s cells are less responsive or completely unresponsive to androgens like testosterone. This can lead to varied degrees of masculinisation.
• Testosterone Levels: The dose and levels of testosterone achieved through therapy play a crucial role. Inadequate dosing or irregular therapy can lead to suboptimal levels, impacting the effectiveness of masculinisation.

3. Managing Testosterone Therapy:

• Monitoring Levels: Regular monitoring of testosterone levels is essential to ensure they are within the target range for effective masculinisation.
• Adjusting Dosage: Based on blood tests and response to therapy, the dosage of testosterone may need to be adjusted. In cases of androgen insensitivity, higher doses might be required.
• Adjusting the formulation: If you are not seeing the developments you desire, then maybe changing from one preparation to another may help. Try gels or other injections or what is available in your country.
• Regular Follow-Ups: Frequent follow-up reviews are crucial to assess progress and make necessary adjustments to the treatment plan.

4. Treatment Adjustments:

• Increase testosterone levels to a more effective range by increasing the dose and / or frequency of administration of testosterone.
• Closely monitor the response to this adjusted regimen, both through clinical assessment and regular blood tests, to evaluate progress in masculinisation and make further adjustments if needed.