“The nurse says a blood result needs talking about — I’ve waited years for this, so nobody’s touching my dose”

Testosterone therapy in trans men commonly raises haemoglobin and haematocrit (erythrocytosis), which increases the risk of thrombosis and stroke. Shared-care protocols from NHS gender services set monitoring and action thresholds; a haematocrit above about 0.54 usually prompts repeating the test, looking for contributing factors and contacting the gender service about dose or interval adjustment, rather than stopping testosterone. Contributing factors include supratherapeutic or self-adjusted dosing, smoking, obstructive sleep apnoea, dehydration and lung disease. RCGP guidance describes the GP’s role as working with specialist gender services, including prescribing and monitoring under shared care. Respectful care means using the person’s name and pronouns and recognising how much treatment matters to them. The hidden agenda is a common, dangerous myth: testosterone does not reliably suppress ovulation, so trans men with a uterus who have vaginal sex with partners who produce sperm can become pregnant, and testosterone can harm a developing pregnancy. CoSRH guidance advises non-oestrogen methods for people using testosterone: copper IUD, LNG-IUS, progestogen-only implant or injection (and the progestogen-only pill). Emergency contraception options are the same as for anyone else; a copper IUD is the most effective, and oral levonorgestrel or ulipristal acetate can be used, with no interaction with testosterone (check the SPC). Arrange a pregnancy test now and 3 weeks after the last unprotected sex, offer an STI screen, and if pregnant, stop testosterone and seek urgent advice. People registered as male are not automatically invited for cervical screening; anyone with a cervix aged 25–64 should be offered it.