Cross-Sex Hormone Therapy in Trans Persons Is Safe and Effective at Short-Time Follow-Up: Results from the European Network for the Investigation of Gender Incongruence

Abstract

Introduction. Data on the effects of cross-sex hormone therapy (CHT) are limited due to the low prevalence of gender dysphoria, small number of subjects treated at each center, lack of prospective studies, and wide variations in treatment modalities. Aim. The aim of this study is to report the short-term effects of CHT on hormonal and clinical changes, side effects, and adverse events in trans men (female-to-male gender dysphoric persons) and trans women (male-to-female gender dysphoric persons). Methods. This was a multicenter 1-year prospective study in 53 trans men and 53 trans women. Trans men received injections of testosterone undecanoate every 3 months. Trans women younger than 45 years received 50 mg cyproterone acetate (CA) and 4 mg estradiol valerate daily, whereas those older than 45 years received 50 mg CA daily together with 100 μg/24 hours transdermal 17-β estradiol. Main Outcome Measures. Sex steroids, prolactin, liver enzymes, lipids, hematocrit, blood pressure, anthropometrics, Ferriman and Gallwey score, and global acne grading scale were measured. Side effects, adverse events, and desired clinical changes were examined. Results. No deaths or severe adverse events were observed. Two trans men developed erythrocytosis, and two had transient elevation of the liver enzymes. Trans men reported an increase in sexual desire, voice instability, and clitoral pain (all P ≤ 0.01). Testosterone therapy increased acne scores, facial and body hair, and prevalence of androgenetic alopecia. Waist-hip ratio, muscle mass, triglycerides, total cholesterol (C), and LDL-C increased, whereas total body fat mass and HDL-C decreased. Three trans women experienced transient elevation of liver enzymes. A significant increase in breast tenderness, hot flashes, emotionality, and low sex drive was observed (all P ≤ 0.02). Fasting insulin, total body fat mass, and prolactin levels increased, and waist-hip ratio, lean mass, total C, and LDL-C decreased. Conclusions. Current treatment modalities were effective and carried a low risk for side effects and adverse events at short-time follow-up. Wierckx K, Van Caenegem E, Schreiner T, Haraldsen I, Fisher A, Toye K, Kaufman JM, and T'Sjoen G. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: Results from the European Network for the Investigation

Adult development and quality of life of transgender and gender nonconforming people

“…While serious short-term complications of gender-affirming hormone therapy appear uncommon (123), the longer-term effects on vulnerability to cardiovascular disease, metabolic disease, and cancer are not well understood (124). Studies that examined the effects of hormones on the brain (125, 126, 121) showed dramatic changes in intracranial volume, cortical thickness, volume of sub-cortical structures, and fractional anisotropy.…”

Transgender and gender nonconforming adolescent care

“…For FTM patients who are on testosterone, they should be aware that testosterone is contraindicated in pregnancy and may have adverse effects on a developing fetus. Exogenous testosterone may increase sexual desire and clitoral pain (17). Male to female (MTF) patients on estrogen therapy may experience decreased sexual desire as a side effect of decreased testosterone concentrations (17,18).…”

“…Exogenous testosterone may increase sexual desire and clitoral pain (17). Male to female (MTF) patients on estrogen therapy may experience decreased sexual desire as a side effect of decreased testosterone concentrations (17,18). Decreased libido may also be a side effect of puberty suppressing medications (18).…”

“…At age 35, he was found to have bone mineral density above the 50 th percentile for females, normal serum values for lipids, hemoglobin A1C, glucose and insulin, and was living happily as a man without regrets regarding his gender transition. A more recent study of the short-term effects of cross-sex hormone therapy in FTM patients found that there were no deaths or severe adverse effects (17). Of 53 FTM patients, two had erythrocytosis and two had transient elevation of liver enzymes.…”

Multiparameter Investigation of a 46,XX/46,XY Tetragametic Chimeric Phenotypical Male Patient with Bilateral Scrotal Ovotestes and Ovulatory Activity

“…Elevated prolactin levels have previously been observed in males with high estradiol levels, for example due to a feminizing adrenal tumor [Subbiah et al, 2011]. Hyperprolactinemia has also been reported in up to 4% of transgender women (femaleidentifying individuals assigned male at birth) treated with estrogens [Wierckx et al, 2014].…”