Physical Aspects of Transgender Endocrine Therapy

Abstract

The goal of transgender endocrine therapy is to change secondary sex characteristics to reduce gender dysphoria and/or facilitate gender presentation that is consistent with the felt sense of self. To maximize desired effects and minimize adverse effects, endocrine therapy must be individualized based on the patient's goals, the risk/benefit ratio of medications, the presence of other medical conditions, and consideration of social and economic issues. In this article we suggest protocols for the prescribing clinician relating to physical assessment, prescription planning, initiation of endocrine therapy, and ongoing maintenance in transgender adults.

Epidemiology of advanced prostate cancer: Overview of known and less explored disparities in prostate cancer prognosis

“…35 Very little is known about the effects of contrasex hormones and sex reassignment surgery on the risk of age-related chronic conditions such as osteoporosis, diabetes, cardiovascular disease, and (with the exception of anecdotal case reports and hypothetical discussions) no empirical data can be found on the risk of cancer. 36 During hormone treatment, MTF individuals (transwomen) receive estrogen as well as an antiandrogen therapy, creating an environment in which the prostate is androgen deprived. 37 Hormone replacement therapy is continued after sex reassignment surgery and many transwomen continue it until death, fearing that the development of secondary sex characteristics may recede.…”

Hormone Therapy in Adults: Suggested Revisions to the Sixth Version of theStandards of Care

“…It is not approved for use in the United States due to concerns over hepatoxicity (Thole, Manso, Salgueiro, Revuelta, & Hidalgo, 2004). Spironolactone is commonly used as an antiandrogen in feminizing hormone therapy, particularly in regions where cyproterone is not approved for use (Dahl, Feldman, Goldberg, & Jaberi, 2006;Moore et al, 2003;Tangpricha et al, 2003). Spironolactone has a long history of use in treating hypertension and congestive heart failure, and its common side effects include hyperkalemia, dizziness, and gastrointestinal symptoms (Physicians' Desk Reference, 2007).…”

“…With appropriate training, feminizing and masculinizing hormone therapy can be managed by a variety of providers, including nursepractitioners and primary care physicians (Dahl et al, 2006). Medical visits relating to hormone maintenance provide an opportunity for broader care to a population that is often medically underserved (Clements, Wilkinson, Kitano, & Marx, 1999;Feldman, 2007;Xavier, 2000).…”

“…The maintenance dose is then adjusted for change in health conditions, aging, or other considerations (e.g., lifestyle changes (Dahl et al, 2006). Upon presenting for maintenance hormones, the provider should assess the patient's current regimen for safety and drug interactions and substitute safer medications or doses when indicated.…”

Cancer in Transgender People: Evidence and Methodological Considerations

“…Whereas cancer among transgender people is listed among research priorities (10), most of the concerns pertaining to the occurrence and outcomes of malignant tumors in this population are based on anecdotal evidence or on the general considerations of possible disease mechanisms (13)(14)(15)(16)(17)(18). The high quality empirical data assessing cancer incidence and mortality among transgender people are lacking primarily because of an absence of large-scale prospective studies of this population (19).…”