Risk of stroke in females using testosterone

[ArabellaScott]

https://www.neurology.org/doi/10.1212/WNL.0000000000202704

Disturbing case of a 'transman' who had a stroke age 23 and subsequently has 'locked in' syndrome. Paper from 2023.

'There is little existing data for stroke risk factors in the LGBTQI+ community. Prior research has shown testosterone therapy in cis-gender men with initially low levels of testosterone increases the risk of stroke, especially in the first 2 years of use1. While testosterone therapy has been shown to increase the risk of venous thrombosis, its role in arterial thrombosis is unclear2. A proposed mechanism for thrombosis with testosterone replacement includes erythrocytosis, but the potential contribution of an independent pro-coagulant effect is yet to be determined3.'

'Conclusions:

Acute ischemic stroke may be an under recognized complication of testosterone therapy in transgender males independent of degree of erythrocytosis. Further research is needed to establish a safety profile of testosterone therapy in this understudied population.'

Strokes in the very young aren't unknown, but I do hope the research is done properly if this link to testosterone treatment is real. It's clear that medical complacency needs to stop. Just cos they're 23, it doesn't make the poor sod bomb proof.

frustratingly, I'm not sure the research always disaggregates for sex, which is obviously crucial.

So they have a woman who had a stroke after taking high levels of testosterone but the background only mentions the impact of testosterone on men?

As I understand it there’s been huge opposition to doing this sort of research. If trans people received proper follow-up care we’d know far more about the health risks of “gender affirming care” as well as having more accurate numbers of detransitioners (& an understanding of why they’ve detransitioned & when).

This, combined with the fact so-called “gender affirming” genital surgery has no standard of care because the procedures are still experimental, with surgeons doing their own thing & refusing to correct the work of others when there are issues… it’s frankly a scandal all the way through,

The research I found on googling was from a while back, preceding - I imagine - the huge surge in young women taking T. So most taking it would then have been males.

But what relevance does that have?

Exactly. There's fuck all research been done (as far as I'm aware) of testosterone effects in females.

Who knows? They're using Humpty Dumpty language: testosterone therapy in transgender males - what does that even mean?

I think it refers to females with a trans identity, because why would a male with a trans identity have testosterone therapy?

Good god, awful for the poor person with locked in syndrome, but FFS, pumping a body full of cross sex hormones, it's not exactly a huge shocker that doing so can fuck things right up, is it?

All this 'transgender medical care' will be the scandal of the fucking century provided it's not just hushed up.

I have friends and family with sarcopenia. Some of them are women and the last time that I looked at the research for women, supplementary T wouldn't make much contribution to muscle mass gain, muscle quality or maintenance for the middle-aged and greater age groups in question and there was a known heightened risk of stroke.

I would expect younger people to accrue greater benefit from T dosing. It would be remarkably unfortunate if they're not given an accurate overview of the relative increase in various risks. However, it's understandable if there's just no data. Yet again, what a boon it would have been had the child or adult clinical services in this area monitored, collated, reported and audit data that might yield insight into these issues.

There is this, but I am imagining the dosage is going to be different for menopausal women using T than for younger women using it to 'transition'.

https://www.ahajournals.org/doi/10.1161/str.48.suppl_1.tp197

'Use of testosterone-containing HRT slightly increased the risk of stroke in women when compared to progesterone alone HRT, although this was not found to be significant. Stroke risk with Estratest may be considered to be similar to estrogen only and combination of estrogen plus progesterone HRT. Future studies are required to investigate these correlations.'

Doses for menopausal women, from the British Menopause Society:

Testim gel [Endo Ventures Ltd] 1% testosterone gel in 5ml tubes: Starting dose 0.5ml (5mg)
per day making each tube last for 10 days.
• Tostran [Kyowa Kirin Ltd] (2% testosterone gel in a canister containing 60g ) : Starting dose 1 metered pump of 0.5g = 10mg on alternate days – each canister should last 240 days.
• Testogel [Besins Healthcare UK] (2.5g sachets containing 40.5mg testosterone): Starting dose
1/8 of a sachet/day = approx. 5mg/day i.e. each sachet should last 8 days. (new formulation)
• AndroFeme cream [Lawley Pharma] (1% testosterone cream in 50ml tubes with screw cap):
Starting dose 0.5ml/day = 5mg /day i.e. each tube should last 100 days.

From NHS guidance on T dosing for 'transmen'

Testogel®(1 actuation = 20.25mg)
Tostran®
(1 actuation = 10mg)
Typical dose range is 50-100 mg once daily

IM Injection Sustanon 250® 250 mg every 2-4 weeks

M Injection Nebido® 1000mg/4mL 1000 mg every 10-14 weeks'

Taking Testogel as a direct comparision, the dosing for menopause is 5mg per day, whereas it's 50-100mg per day for a 'transman'.

It really is medical neglect, isn't it. I'm not sure anyone can justify the risks these medical "experts" have taken, and continue to take, with their patients.
It's going to make thalidomide and lobotomy surgery look like a picnic, I fear, and those were horrific.

It's stupefying the way some people still argue for trans exceptionalism. As though they are immune from these evils. Yet we are considered the bad guys because we don't want them (or anyone else) to come to harm. Thank heavens for sunlight

As I understand it there’s been huge opposition to doing this sort of research.
This is my understanding too.
A friend of a friend was blocked from doing research in this field about 5-10 years ago now.

Edited to add, I know a transman who has developed a range of autoimmune health issues some years after starting 'T'. No one seems to be making any connections

It is beyond the wit of most people to work out how the medical profession has allowed itself to be put in this ludicrous position.
Unevidenced, unlicensed medication, prescribed to people who are not fully developed, in the name of "suicide prevention ", a totally false, unevidenced, claim. For a condition which has no recognised diagnostic test, of any kind.

Those pushing the gender view can't even comprehend that people saying that we need to look at the risks of certain medical treatments aren't just saying this to be mean. It never crosses their mind that assessing things properly may result in treatments being able to continue but with additional drugs to help counteract the risks. Treatments that affect bones for example, could be allowed but with regular monitoring and lifestyle changes to help prevent injury.

It really shows that seeing the world through gender blinkers stops people from seeing the good as well as the bad

A lot of them really believe that people can change sex. That if a female human has enough testosterone in her body she will actually be a man and therefore at no greater risk than a male human.

It can't really be as simple as people (medics?) thinking 'testosterone is a male hormone, so if we give it to women they will get male bodies,' can it?

Unevidenced, unlicensed medication, prescribed to people who are not fully developed, in the name of "suicide prevention ", a totally false, unevidenced, claim. For a condition which has no recognised diagnostic test, of any kind.

And anyone questioning that narrative is 'transphobic'.

I wonder if any researchers can get their hands on the medical records of all the east German female athletes who were given testosterone in the late 70s and early 80s. If I'm not mistaken they all died very young and many from heart attacks and strokes, they also suffered from many other life long medical problems due to the drugs the were given. I remember seeing a documentary about 1 of the former athletes in the late 90s early 00s and it was heartbreaking to watch and yet we are consigning so many young women to the same fate and calling it lifesaving

Yes, Sharron Davies spoke about the girl who won gold when she won silver. I think it was the Triggernometry interview. Horrible medical issues in most, if not all, of these abused young girls.

There were criminal trials of some of those involved in doping, in Berlin, between 1998 and 2000. Evidence from those trials might be enlightening.

However, the widespread use of anabolic steroids might make it difficult to tease out what health problems were caused by testosterone and what by steroids.

There may be something in the book 'Faust’s Gold: Inside the East German Doping Machine' by Steven Ingerleider (which I have not read).

I hadn't realised the scale of the programme.

'The massive doping programme is reported to have involved tens of thousands of athletes - many of them children.
"It was not possible to refuse," explained Professor Giselher Spitzer, a sports historian at Potsdam University who has studied the programme.
Dr Spitzer said that the youngsters targeted in particular were ice skaters and gymnasts.
In total, two million tablets were given out each year to sportsmen and women.
The results have been horrendous for some of the athletes. The worst case is that of George Severs, who was found at the bottom of a swimming pool having suffered heart failure.
His parents were told he had drowned as a result of feeling weak from flu. It would be 20 years before the autopsy report showed he died due to toxic damage to the liver.
Today, it is estimated that around 10,000 former athletes bear the physical and mental scars of years of drug abuse.'

http://news.bbc.co.uk/1/hi/world/europe/4341045.stm

I hadn't realised the scale of the programme.

I don't recall where I read this but the implication was that truly remarkable numbers of young people with potential were dosed.

The expectation was that, with training, they would come from nowhere, dominate or be competitive in a category, and then disappear, never to be heard of again. They'd be replaced by the next young hopeful in the pipeline. Rinse and repeat.

The collateral damage of those used in this way, and those who didn't make it through to high status competition, was, as you indicate, a remarkable number.

Interesting observation here that hints that data might exist somewhere in a relevant population:

By the 1980s, steroid was widespread globally. But doping in East Germany was world class. As PBS states, “doping in the GDR was different from the doping in the rest of the world but it was also different from the doping in other parts of the East. It was German, it was orderly, it was bureaucratic, it was written up.”

https://theolympians.co/2016/06/21/the-unseemly-story-of-christiane-knack-and-the-east-german-doping-machine-all-in-all-youre-just-another-brick-in-the-wall/