For a transgender patient requiring vitamin D replacement with a level of 23 ng/dL, which protocol is most appropriate?

For a transgender patient with a vitamin D level of 23 ng/dL, the most appropriate protocol is the one that allows for an aggressive approach to correcting significant vitamin D deficiency. The initial high dose of 100,000 units given intramuscularly (IM) ensures a quick replenishment of vitamin D stores, particularly when serum levels are notably low. The subsequent administration of 50,000 units every two weeks for eight weeks provides a continuous supply to help maintain adequate levels as the body's stores are replenished.

This method is particularly suitable for individuals with severe deficiencies or those at risk of complications associated with low vitamin D levels, including poor bone health and immunity. In the case of a transgender patient, who may have specific healthcare needs including bone density considerations related to hormone therapy, a robust initial treatment protocol is especially important.

Other protocols listed, such as daily dosing, may be less effective for certain patients with more severe deficiencies, as they may not raise blood levels quickly enough compared to the initial large doses designed to address significant deficits. Additionally, longer-term protocols with lower doses may not adequately address the immediate need for increased vitamin D levels in the short term, especially when starting from a relatively low baseline.