Testosterone allergy and desensitization
Question:
5/16/2019
I have a patient transitioning from female to male and is having allergic reactions to the testosterone injections. Site becomes red severely itchy swollen and hard with symptoms lasting more than a week. There's reactivation of prior injection sites with new injections. PMD has changed formulation with continued reaction. She states this is much more severe than normal irritation for testosterone. There's no other systemic symptoms. SPT is + to testosterone cypionate and testosterone enanthate but negative for sesame (the vehicle). He wishes to continue with medication but am worried it will lead to systemic involvement- any advice on a desensitization protocol? There's nothing in the literature that I could find.
Answer:
As you noted, literature about testosterone desensitization is lacking. However, there are several reports about progesterone desensitization, so you might consider creating a protocol based on one of those articles. A recent paper by Li RC et al in Curr Allergy Asthma Rep 2018 Jan 19; 18(1):1 includes a helpful table and references.
As an aside, I did find a case report of anaphylaxis to benzyl benzoate in a preparation of dept testosterone undecanoate, but desensitization was not pursued in this case. (Ref Ong GSY et al in Case Rep Med. 2012;PMID 22272209).
I hope this information is useful to you.
Best regards,
Jacqueline A. Pongracic, MD, FAAAAI