Urine and Serum Sex Steroid Profile in Testosterone-Treated Transgender and Hypogonadal and Healthy Control Men

J Clin Endocrinol Metab. 2018 Jun 1;103(6):2277-2283. doi: 10.1210/jc.2018-00054.


Background: The impact of testosterone (T) treatment on antidoping detection tests in female-to-male (F2M) transgender men is unknown. We investigated urine and serum sex steroid and luteinizing hormone (LH) profiles in T-treated F2M men to determine whether and, if so, how they differed from hypogonadal and healthy control men.

Method: Healthy transgender (n = 23) and hypogonadal (n = 24) men aged 18 to 50 years treated with 1000 mg injectable T undecanoate provided trough urine and blood samples and an additional earlier postinjection sample (n = 21). Healthy control men (n = 20) provided a single blood and urine sample. Steroids were measured by mass spectrometry-based methods in urine and serum, LH by immunoassay, and uridine 5'-diphospho-glucuronosyltransferase 2B17 genotype by polymerase chain reaction.

Results: Urine LH, human chorionic gonadotropin, T, epitestosterone (EpiT), androsterone (A), etiocholanolone (Etio), A/Etio ratio, dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT), and 5α,3α- and 5β,3α-androstanediols did not differ between groups or by time since last T injection. Urine T/EpiT ratio was <4 in all controls and 12/68 (18%) samples from T-treated men, but there was no difference between T-treated groups. Serum estradiol, estrone, and DHEA were higher in transgender men, and serum T and DHT were higher in earlier compared with trough blood samples, but serum LH, follicle-stimulating hormone, and 3α- and 3β,5α-diols did not differ between groups.

Conclusion: Urine antidoping detection tests in T-treated transgender men can be interpreted like those of T-treated hypogonadal men and are unaffected by time since last T dose. Serum steroids are more sensitive to detect exogenous T administration early but not later after the last T dose.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Androgens / blood
  • Androgens / metabolism*
  • Androgens / urine
  • Androsterone / blood
  • Androsterone / urine
  • Dehydroepiandrosterone / blood
  • Dehydroepiandrosterone / urine
  • Dihydrotestosterone / blood
  • Dihydrotestosterone / urine
  • Estradiol / blood
  • Estradiol / urine
  • Estrogens / blood
  • Estrogens / metabolism*
  • Estrogens / urine
  • Estrone / blood
  • Estrone / urine
  • Humans
  • Hypogonadism / blood
  • Hypogonadism / drug therapy*
  • Hypogonadism / urine
  • Luteinizing Hormone / blood
  • Luteinizing Hormone / urine
  • Male
  • Mass Spectrometry
  • Middle Aged
  • Testosterone / analogs & derivatives*
  • Testosterone / blood
  • Testosterone / therapeutic use
  • Testosterone / urine
  • Transgender Persons
  • Transsexualism / blood
  • Transsexualism / drug therapy*
  • Transsexualism / urine
  • Young Adult


  • Androgens
  • Estrogens
  • Dihydrotestosterone
  • Estrone
  • Testosterone
  • Dehydroepiandrosterone
  • Estradiol
  • Luteinizing Hormone
  • Androsterone
  • testosterone undecanoate