A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria

Abstract

This review focuses on the effect that cross-gender sex steroid therapy has on metabolic and hormonal parameters. There is an emphasis on those changes that result in significant clinical effects such as the positive effects of the development of secondary sexual characteristics and negative effects such as haemostatic effects and thromboembolism in transwomen or dyslipidaemia in transmen. There is also a description of the current hormonal regimens used at the largest UK gender identity clinic. The overall safety of these treatments in the context of long-term outcome data is reviewed.

Metabolic Effects Of Hormone Therapy In Transgender Patients

“…While there was a statistically significant difference between cisgender men and cisgender women, transgender women HDL levels were found to lie intermediate to the cisgender averages, not significantly deviating from either [6]. Two papers suggest that there is no change in either total cholesterol or HDL after hormone therapy for transgender women [7], [8]. Additionally, two papers note a significant increase in triglycerides for transgender women [6], [8], while other studies reported no change in triglycerides [7].…”

The Perioperative Care of the Transgender Patient

“…In a Dutch study, the incidence of thrombosis was 20 times greater in the first 2 years of estrogen therapy. 42 Risk rises in patients who smoke and those on oral estrogen preparations (conjugated estrogens and ethinylestradiol). Some surgeons advocate discontinuance of hormones 2–4 weeks before surgery.…”

“…While there is triglyceride elevation (albeit no alteration in total cholesterol), myocardial infarction rates among transgender men are only one third that of their cisgender male counterparts. 42 Adverse effects such as erythrocytosis, liver dysfunction, lipid level changes, acne, and adverse psychological changes can also occur. 44 If patients stop their hormones for longer periods, this can result in reversal of the masculinizing effects, including loss of muscle mass and resumption of menses.…”

“…53 However, parenteral testosterone formulations are also associated with a greater incidence of erythropoietin production and hematocrits >48% are linked to higher rates of stroke due to greater blood viscosity. 42,54 Preexisting coronary artery disease and testosterone therapy warrant careful consideration during anesthesia induction, maintenance, and intraoperative monitoring to prevent cardiovascular complications.…”

The primary health care of transgender adults

“…29,30 The effect of exogenous testosterone on carbohydrate metabolism is unclear. 13,31,32 No studies have demonstrated an increase in risk of cardiovascular events among transmen using testosterone.…”