Three years ago, Thao weighed 50 kg and had a slender build. After weekly testosterone injections for masculinization, Thao's weight increased to 75 kg, reaching a BMI of 30, considered obese by the World Health Organization (WHO).

The day before being admitted to Tam Anh General Hospital in Ho Chi Minh City, Thao experienced a dull ache in her left hip. The following day, the pain intensified, accompanied by nausea, prompting her to seek emergency care. Dr. Ngo Thi Binh Lua, from the hospital's Obstetrics and Gynecology Center, found a 10x12x11 cm cyst on Thao's left ovary. The cyst had twisted around its stalk, cutting off blood circulation and causing necrosis. Thao underwent laparoscopic surgery to remove the entire left ovary, including the cyst. The cyst contained hair, bone fragments, and scalp tissue. A biopsy confirmed it was a benign teratoma.

Dr. Binh Lua (far right) and the surgical team performing the laparoscopic ovarian removal. Photo: *Thanh Luan*

"Testosterone promotes male characteristics, significantly impacting the body's metabolism and increasing visceral fat, leading to obesity," Dr. Lua explained. Some individuals, especially in the initial stages of hormone therapy before the ovaries fully shrink, may develop cysts or tumors. Weight gain, abdominal fat, and increased abdominal pressure can cause these cysts or tumors to twist, obstructing blood supply and leading to necrosis. Thao is currently exercising to lose weight, attending regular check-ups, and undergoing more frequent hormone level monitoring.

A 2021 study published on PubMed, involving 470 transgender men in the US, showed an average weight gain of 2.35 kg after 2-4 months of gender-affirming hormone therapy. After 11-21 months, about 30% of participants had gained over 5 kg.

According to Dr. Lua, self-administering hormones without medical supervision and proper testing poses risks such as endocrine disorders and metabolic complications including increased cholesterol, high blood lipids, insulin resistance, type 2 diabetes, hypertension, cardiac hypertrophy, and an increased risk of stroke. Long-term high doses can also affect the liver and kidneys.

Dr. Lua recommends that individuals undergoing gender-affirming hormone therapy have regular blood tests to monitor hormone levels, liver and kidney function, and blood lipids. They should also have abdominal ultrasounds and gynecological screenings if they haven't had a hysterectomy or oophorectomy, and maintain a healthy weight.

Side effects from gender-affirming hormones can develop gradually. Warning signs include rapid weight gain, increased abdominal fat, acne, hair loss, chest pain or rapid heartbeat, hypertension, menstrual irregularities or cessation, jaundice, irritability, and mood swings.

Tue Diem

*The patient's name has been changed.