Relationship between testosterone in serum, saliva and urine during treatment with intramuscular testosterone undecanoate in gender dysphoria and male hypogonadism

Abstract

Long-term testosterone replacement therapy is mainly monitored by trough levels of serum testosterone (S-T), while urinary testosterone (U-T) is used by forensic toxicology to evaluate testosterone doping. Testosterone in saliva (Sal-T) may provide additional information and simplify the sample collection. We aimed to investigate the relationships between testosterone measured in saliva, serum and urine during standard treatment with 1,000 mg testosterone undecanoate (TU) every 12th week during 1 year. This was an observational study. Males with primary and secondary hypogonadism (HG; n = 23), subjects with gender dysphoria (GD FtM; n = 15) and a healthy control group of men (n = 32) were investigated. Sal-T, S-T and U-T were measured before and after TU injections. Sal-T was determined with Salimetrics enzyme immunoassay, S-T with Roche Elecsys testosterone II assay and U-T by gas chromatography-mass spectrometry. Sal-T correlated significantly with S-T and calculated free testosterone in both controls and patients (HG men and GD FtM), while Sal-T to U-T showed weaker correlations. Trough values of Sal-T after 12 months were significantly higher in the GD FtM group (0.77 ± 0.35 nmol/L) compared to HG men (0.53 ± 0.22 nmol/L) and controls (0.46 ± 0.15 nmol/L), while no differences between S-T and U-T trough values were found. Markedly elevated concentrations of salivary testosterone, 7-14 days after injection, were observed, especially in the GD FtM group. This study demonstrates that Sal-T might be a useful clinical tool to monitor long-term testosterone replacement therapy and might give additional information in forensic cases.

Detection of testosterone doping in female athletes

“…Given the extreme but transient elevations of serum T concentration in otherwise healthy young females are not consistent with any known physiological, pharmacological, or pathological conditions, it is highly likely that these findings are due to administration of exogenous T. Previous reports have investigated serum T measurement by LC–MS to detect exogenous T in experimental studies of men administered one or multiple doses of testosterone gel or testosterone ester injections . However, there is only a single study in women .…”

“…Given the extreme but transient elevations of serum T concentration in otherwise healthy young females are not consistent with any known physiological, pharmacological, or pathological conditions, it is highly likely that these findings are due to administration of exogenous T. Previous reports have investigated serum T measurement by LC-MS to detect exogenous T in experimental studies of men administered one or multiple doses of testosterone gel 13,[21][22][23][24][25] or testosterone ester injections. [26][27][28] However, there is only a single study in women. 29 In that study, ten Japanese women (six with homozygous and three with heterozygous UGT2B17 deletion genotype) administered a single intramuscular injection of 100 mg T enanthate mostly displayed small increases (not exceeding 1.5) of urine T/E ratio.…”

Effects of Ginseng Ingestion on Salivary Testosterone and DHEA Levels in Healthy Females: An Exploratory Study

“…These binding proteins can act as a reservoir for the steroid and protect it against extensive metabolism of active (free) steroids during passage of the blood through the liver [58]. Recently, salivary and serum testosterone levels were found to correlate significantly with calculated free testosterone in both controls and patients, whereas salivary and urine testosterone showed weaker correlations [59]. Other researchers reported that the correlation of serum and salivary concentrations taken before and after exercise was not as consistent as that observed during rest [60].…”

A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha (Withania somnifera) in Aging, Overweight Males

“…To increase compliance and reduce the demands on participants, hormonal concentrations were evaluated via fasting salivary collections rather than in serum. It has been confirmed in several studies that salivary measurements of testosterone, DHEA-S, cortisol, and estradiol correlate well with serum levels (Arregger, Contreras, Tumilasci, Aquilano, & Cardoso, 2007;Francavilla et al, 2018;Lood et al, 2018). However, their accuracy as an outcome measure can be compromised by their rapid diurnal variability (Wood, 2009).…”