Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study

Blok, Christel J.M. de; Klaver, Maartje; Wiepjes, Chantal M.; Nota, Nienke M.; Heijboer, Annemieke C.; Fisher, Alessandra D.; Schreiner, Thomas; T’Sjoen, Guy; Heijer, Martin den

doi:10.1210/jc.2017-01927

Cited by 70 publications

(75 citation statements)

References 21 publications

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“… 8 Transgender people can receive gender affirming hormones (sex steroids) to reduce psychological distress and to induce desired physical changes, such as for body hair and body composition. 9 10 In trans women (male sex assigned at birth, female gender identity), treatment usually consists of antiandrogens and oestrogens. In trans men (female sex assigned at birth, male gender identity), treatment usually consists of testosterone.…”

Section: Introductionmentioning

confidence: 99%

Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands

Blok

Wiepjes

Nota

et al. 2019

BMJ

Self Cite

249

261

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ObjectiveTo investigate the incidence and characteristics of breast cancer in transgender people in the Netherlands compared with the general Dutch population.DesignRetrospective, nationwide cohort study.SettingSpecialised tertiary gender clinic in Amsterdam, the Netherlands.Participants2260 adult trans women (male sex assigned at birth, female gender identity) and 1229 adult trans men (female sex assigned at birth, male gender identity) who received gender affirming hormone treatment.Main outcome measuresIncidence and characteristics (eg, histology, hormone receptor status) of breast cancer in transgender people.ResultsThe total person time in this cohort was 33 991 years for trans women and 14 883 years for trans men. In the 2260 trans women in the cohort, 15 cases of invasive breast cancer were identified (median duration of hormone treatment 18 years, range 7-37 years). This was 46-fold higher than in cisgender men (standardised incidence ratio 46.7, 95% confidence interval 27.2 to 75.4) but lower than in cisgender women (0.3, 0.2 to 0.4). Most tumours were of ductal origin and oestrogen and progesterone receptor positive, and 8.3% were human epidermal growth factor 2 (HER2) positive. In 1229 trans men, four cases of invasive breast cancer were identified (median duration of hormone treatment 15 years, range 2-17 years). This was lower than expected compared with cisgender women (standardised incidence ratio 0.2, 95% confidence interval 0.1 to 0.5).ConclusionsThis study showed an increased risk of breast cancer in trans women compared with cisgender men, and a lower risk in trans men compared with cisgender women. In trans women, the risk of breast cancer increased during a relatively short duration of hormone treatment and the characteristics of the breast cancer resembled a more female pattern. These results suggest that breast cancer screening guidelines for cisgender people are sufficient for transgender people using hormone treatment.

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Section: Introductionmentioning

confidence: 99%

Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands

Blok

Wiepjes

Nota

et al. 2019

BMJ

Self Cite

249

261

View full text Add to dashboard Cite

show abstract

“…Trans women (birth-assigned males, female identity) receive estrogens to induce feminization, resulting, for example, in breast growth (1) and changes in body composition. Trans women (birth-assigned males, female identity) receive estrogens to induce feminization, resulting, for example, in breast growth (1) and changes in body composition.…”

Section: Introductionmentioning

confidence: 99%

“…T ransgender people can receive gender-affirming hormonal treatment (HT) to change the physical characteristics belonging to their experienced gender. Trans women (birth-assigned males, female identity) receive estrogens to induce feminization, resulting, for example, in breast growth (1) and changes in body composition. (2) Trans men (birth-assigned females, male identity) are treated with testosterone, which, among others, stimulates lowering of the voice (3) and growth of body hair.…”

Section: Introductionmentioning

confidence: 99%

Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study

Wiepjes

Blok

Staphorsius

et al. 2019

Journal of Bone and Mineral Research

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Concerns about bone health in transgender people using gender‐affirming hormonal treatment (HT) exist, but the fracture risk is not known. In this nationwide cohort study, we aimed to compare the fracture incidence in transgender people using long‐term HT with an age‐matched reference population. All adult transgender people who started HT before 2016 at our gender‐identity clinic were included and were linked to a random population‐based sample of 5 age‐matched reference men and 5 age‐matched reference women per person. Fracture incidence was determined using diagnoses from visits to hospital emergency rooms nationwide between 2013 and 2015. A total of 1089 trans women aged <50 years (mean 38 ± 9 years) and 934 trans women aged ≥50 years (mean 60 ± 8 years) using HT for median 8 (interquartile range [IQR] 3–16) and 19 (IQR 11–29) years, respectively, were included. A total of 2.4% of the trans women aged <50 years had a fracture, whereas 3.0% of the age‐matched reference men (odds ratio [OR] = 0.78, 95% confidence interval [CI] 0.51–1.19) and 1.6% of the age‐matched reference women (OR = 1.49, 95% CI 0.96–2.32) experienced a fracture. In trans women aged ≥50 years, 4.4% experienced a fracture compared with 2.4% of the age‐matched reference men (OR = 1.90, 95% CI 1.32–2.74) and 4.2% of the age‐matched reference women (OR = 1.05, 95% CI 0.75–1.49). A total of 1036 trans men (40 ± 14 years) using HT for median 9 (IQR 2–22) years were included. Fractures occurred in 1.7% of the trans men, 3.0% of the age‐matched reference men (OR = 0.57, 95% CI 0.35–0.94), and 2.2% of the age‐matched reference women (OR = 0.79, 95% CI 0.48–1.30). In conclusion, fracture risk was higher in older trans women compared with age‐matched reference men. In young trans women, fracture risk tended to be increased compared with age‐matched reference women. Fracture risk was not increased in young trans men. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

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“… vaginoplasty and orchidectomy (“bottom surgery”); bilateral orchidectomy alone; breast augmentation (“top surgery”) — breast development with estradiol can take up to 3 years but remains suboptimal in many; facial feminisation surgery; chondrolaryngoplasty reduces the thyroid cartilage; laryngoplasty and vocal cord surgery can aid voice feminisation; estradiol therapy is typically ceased peri‐operatively to avoid risk of thromboembolism; anti‐androgens are not required following orchidectomy. …”

Section: Recommendationsmentioning

confidence: 99%

Position statement on the hormonal management of adult transgender and gender diverse individuals

Cheung

Wynne

Erasmus

et al. 2019

Medical Journal of Australia

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Introduction Rising demand for gender‐affirming hormone therapy mandates a need for more formalised care of transgender and gender diverse (TGD) individuals in Australia. Estimates suggest that 0.1–2.0% of the population are TGD, yet medical education in transgender health is lacking. We aim to provide general practitioners, physicians and other medical professionals with specific Australian recommendations for the hormonal and related management of adult TGD individuals. Main recommendations Hormonal therapy is effective at aligning physical characteristics with gender identity and in addition to respectful care, may improve mental health symptoms. Masculinising hormone therapy options include transdermal or intramuscular testosterone at standard doses. Feminising hormone therapy options include transdermal or oral estradiol. Additional anti‐androgen therapy with cyproterone acetate or spironolactone is typically required. Treatment should be adjusted to clinical response. For biochemical monitoring, target estradiol and testosterone levels in the reference range of the affirmed gender. Monitoring is suggested for adverse effects of hormone therapy. Preferred names in use and pronouns should be used during consultations and reflected in medical records. While being TGD is not a mental health disorder, individualised mental health support to monitor mood during medical transition is recommended. Changes in management as result of this position statement Gender‐affirming hormone therapy is effective and, in the short term, relatively safe with appropriate monitoring. Further research is needed to guide clinical care and understand long term effects of hormonal therapies. We provide the first guidelines for medical practitioners to aid the provision of gender‐affirming care for Australian adult TGD individuals.

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Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study

Abstract: This study shows that, after 1 year of CHT, breast development is modest and occurs primarily in the first 6 months. No clinical or laboratory parameters were found that predict breast development.

Cited by 70 publications

References 21 publications

Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands

Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands

Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study

Position statement on the hormonal management of adult transgender and gender diverse individuals

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