Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals

Cocchetti, Carlotta; Ristori, Jiska; Romani, Alessia; Maggi, Mario; Fisher, Alessandra D.

doi:10.3390/jcm9061609

Cited by 66 publications

(44 citation statements)

References 54 publications

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“…Notably, people with nonbinary gender identities who seek medical affirmation may undergo partial masculinization with low-dose testosterone therapy to target sex-steroid reference ranges that may be lower than the typical “male” reference range (or conversely, partial feminization). Alternatively, some may desire a slower rate of physical change and hence use low-dose or microdose gender-affirming hormone therapy ( 13 ). While many trans people will seek to update their legal name and gender marker to align with their identity, costs to do so are prohibitive for many ( 14 ).…”

mentioning

confidence: 99%

Approach to Interpreting Common Laboratory Pathology Tests in Transgender Individuals

Cheung

Lim

Cook

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context As the number of transgender (trans) people (including those who are binary and/or non-binary identified) seeking gender-affirming hormone therapy rises, endocrinologists are increasingly asked to assist with interpretation of laboratory tests. Many common laboratory tests such as hemoglobin, iron studies, cardiac troponin and creatinine are affected by sex steroids or body size. We seek to provide a summary of the impact of feminizing and masculinizing hormone therapy on common laboratory tests and an approach to interpretation. Cases Case scenarios discussed include 1) hemoglobin and hematocrit in a non-binary person undergoing masculinizing hormone therapy; 2) estimation of glomerular filtration rate in a trans woman at risk of contrast-induced nephropathy; 3) prostate-specific antigen (PSA) in a trans woman; and 4) chest pain in a trans man with a cardiac troponin concentration in-between the reported male and female reference ranges. Conclusions The influence of exogenous gender-affirming hormone therapy on fat and muscle distribution and other physiological changes determines interpretation of laboratory tests which have sex-specific differences. In addition to affirmative practice to ensure a patient’s name, gender and pronoun are used appropriately, we propose that once individuals have commenced gender-affirming hormone therapy, the reference range of the affirmed gender be reported (and specified by treating clinicians) except for PSA or cardiac troponin which is dependent on organ size. Whilst suggestions may be challenging to implement, they also represent an opportunity to lead best practice to improve the quality of care and experiences of healthcare for all trans people.

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mentioning

confidence: 99%

Approach to Interpreting Common Laboratory Pathology Tests in Transgender Individuals

Cheung

Lim

Cook

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…Under current treatment schema, non-binary people who wish for an androgynous body have limited treatment options. For those AFAB, low-dose testosterone is being used empirically with the aim of reducing feminine features by helping to re-distribute adipose tissue and deepen the voice ( 12 ). Such effects may be difficult to selectively titrate while avoiding other potentially unwanted masculinizing changes such as facial hair growth.…”

Section: Current Treatment Options For Non-binary Trans Peoplementioning

confidence: 99%

“…In addition, chest dysphoria is regularly experienced by trans individuals AFAB, and chest reconstructive surgery can enable removal of unwanted breast tissue for those who have progressed through puberty ( 13 ). Those AMAB may choose to use low-dose estradiol to partially feminize, though the widespread effects of estradiol could potentially cause unwanted feminising changes, such as breast growth ( 12 ). For non-binary adolescents who present in early puberty, long-term GnRHa use may provide a theoretical solution to maintain an androgynous appearance without any secondary sex characteristics ( 15 ).…”

Section: Current Treatment Options For Non-binary Trans Peoplementioning

confidence: 99%

“…Medical treatment with gender-affirming hormones, such as testosterone and estradiol may be appropriate for some non-binary individuals who wish to masculinize or feminize respectively ( 10 , 11 ). However, other non-binary individuals may seek an androgynous body that is neither overtly male nor female, and there is a lack of medical treatment options specifically tested or approved for use in this group to prevent the development of secondary sex characteristics on an ongoing basis ( 12 ). In this article, we therefore consider Selective Estrogen Receptor Modulators (SERMs) as a potential treatment option for non-binary people assigned male at birth (AMAB) who wish to partially feminize without undergoing breast development.…”

Section: Introductionmentioning

confidence: 99%

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Selective Estrogen Receptor Modulators: A Potential Option For Non-Binary Gender-Affirming Hormonal Care?

O’Connell

Notini

et al. 2021

Front. Endocrinol.

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Gender dysphoria describes the distress associated with having a gender identity that differs from one’s birth-assigned sex. To relieve this distress, transgender, and gender diverse (henceforth, trans) individuals commonly undergo medical transition involving hormonal treatments. Current hormonal treatment guidelines cater almost exclusively for those who wish to transition from male to female or vice versa. In contrast, there is a dearth of hormonal options for those trans individuals who identify as non-binary and seek an androgynous appearance that is neither overtly male nor female. Though prolonged puberty suppression with gonadotrophin releasing hormone agonists (GnRHa) could in theory be gender-affirming by preventing the development of unwanted secondary sex characteristics, this treatment option would be limited to pre- or peri-pubertal adolescents and likely have harmful effects. Here, we discuss the theoretical use of Selective Estrogen Receptor Modulators (SERMs) for non-binary people assigned male at birth (AMAB) who are seeking an androgynous appearance through partial feminization without breast growth. Given their unique range of pharmacodynamic effects, SERMs may represent a potential gender-affirming treatment for this population, but there is a lack of knowledge regarding their use and potentially adverse effects in this context.

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“…Surgery without hormone therapy (or vice versa) is also an option, for example an AFAB person opting for top surgery (i.e., mastectomy) without taking testosterone (Jones et al., 2019; Vincent, 2018). Those who choose hormone therapy may opt to receive a lower dose, sometimes called micro‐dosing, which is especially popular with non‐binary people (Coccheti et al., 2020). Some regimens recommend introducing hormone therapy at a low dose and scaling up gradually (Deutsch, 2016a, 2016b; Vincent, 2018).…”

Section: Medical Interventions For Trans People: Relevance For Risk Amentioning

confidence: 99%

Considerations in genetic counseling of transgender patients: Cultural competencies and altered disease risk profiles

Vaupel-Klein

Walsh

2020

Journal of Genetic Counseling

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Transgender people are a growing population with specific healthcare needs, barriers to care, and disease risk factors. Cultural competencies for working with transgender people in healthcare settings are essential to reduce barriers to care and combat the associated health disparities. Genetic counselors support their patients to understand and manage medically and personally complex life events and decisions. A genetic counselor caring for a transgender patient or a patient with a transgender relative will therefore require specific cultural competencies and medical knowledge that may not have been covered in their training. Transgender health is also a relatively young field in which new insights may quickly become fundamental. The present paper therefore provides an overview of current best practices for culturally sensitive working with transgender patients, and an introduction to the additional considerations for assessment of disease risk in transgender people. Guidance on how to ensure communication with patients and other stakeholders is inclusive and affirming of transgender identities, is offered. Medical interventions used for gender transitions are described, and their (potential) effects on cancer and cardiovascular disease risk are discussed. Furthermore, the effects of sociocultural risk factors such as minority stress are outlined. In sum, we invite the reader to consider the specific biological, psychological, and social context of the consultation. Finally, we explore culturally competent approaches to pedigree charting and physical examinations with transgender people and provide recommendations for practice.

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Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals

Cited by 66 publications

References 54 publications

Approach to Interpreting Common Laboratory Pathology Tests in Transgender Individuals

Approach to Interpreting Common Laboratory Pathology Tests in Transgender Individuals

Selective Estrogen Receptor Modulators: A Potential Option For Non-Binary Gender-Affirming Hormonal Care?

Considerations in genetic counseling of transgender patients: Cultural competencies and altered disease risk profiles

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