Introduction
suicidality, depression
MASCULINIZATION
Transgender and gender-diverse individuals (including those with a binary and/or nonbinary gender identity) are a highly marginalized group. Some transgender and gender-diverse individuals experience psychological distress due to the incongruence between their gender identity and sex presumed at birth, known as gender dysphoria. There are also disproportionate rates of mental health comorbidities among transgender and gender-diverse individuals compared with the general population.Some transgender and gender-diverse individuals seek commencement of gender-affirming hormone therapy (GAHT) to permit development of physical characteristics to align with their gender identity. For individuals desiring masculinization, standard doses of parenteral or transdermal testosterone used to treat hypogonadal cisgender men are recommended in consensus guidelines.Commencement of GAHT has been associated with reduced gender dysphoria and depression in cross-sectional and uncontrolled prospective studies.There has been a substantial increase in the number of transgender and gender-diverse individuals seeking GAHTWe undertook a 3-month open-label randomized clinical trial to assess the effect of testosterone therapy vs no treatment on gender dysphoria, depression, and suicidality in transgender and gender-diverse individuals seeking initiation of testosterone therapy. We hypothesized that there would be a reduction in gender dysphoria, depression, and suicidality in transgender and gender-diverse people treated with testosterone therapy compared with transgender and gender-diverse people not receiving testosterone therapy.