madman
Super Moderator
Endocrine treatment of transgender individuals: current guidelines and strategies
Abstract
Introduction: This review provides a summary of the medical and surgical care available to transgender individuals, as well as to offer proposals on how the medical field can progress to provide medically and culturally appropriate care.
Areas covered: Transgender individuals are defined as those whose gender identity differs from that recorded at birth (usually based on visualization of their external sexual anatomy). In order to align the body with the patient’s gender identity, clinicians can provide hormone therapy (HT) either to suppress endogenous sex hormone secretion, to bring sex hormone levels to the range associated with the patient’s gender identity, or both. Once at steady-state, regular monitoring for maintenance of levels, as well as for known risks and complications, is required. The treating clinicians should have knowledge of trans assessment criteria, hormone therapy, surgical options, primary care, and mental health needs of transgender patients. A narrative literature review was conducted using Pubmed and EMBASE with articles then selected for relevance. The following search terms were used initially: androgen suppression, antiandrogen, breast development, chest reconstruction, cisgender, estrogen, fertility preservation, gender-affirming surgery, gender identity, gender incongruence, genital reconstruction, hormone replacement, hyperlipidemia, orchiectomy, prolactin, prostate atrophy, spermatogenesis, spironolactone, testosterone, thrombogenesis, transgender, and virilization.
Expert opinion: Although guidelines exist and examples of high-quality training are readily available, to truly mainstream appropriate high-quality gender-affirming health care there must be a move towards implementing systematic formal training.
Article highlights
• Hormone therapy for transgender men includes testosterone administration to stimulate physical changes consistent with the patient’s gender identity
• Hormone therapy for transgender women includes estrogen and androgen-suppressing agents to stimulate physical changes consistent with the patient’s gender identity
• Associated risks with these therapies must be considered, and routine monitoring dependent on the specific therapy administered is recommended
• In addition to hormone therapy, there are several surgical options available for both transgender men and women to supplement hormone replacement therapy in optimizing these physical changes
• A multi-disciplinary team approach is required to tailor therapy to the individual in achieving their gender identity goals
• Advancement in the management of transgender individuals requires an intentional effort to include training for all providers
2. Hormone regimens for transgender men
2.1 Treatment effects
2.2 Medical risks/safety
2.3 Monitoring
3. Hormone regimens for transgender women
3.1 Treatment effects
3.2 Medical risks/safety
3.3 Monitoring
4. Surgical options
5. Expert Opinion
5.1 Advancement in the medical management of transgender individuals requires an intentional effort to include training for all providers
Abstract
Introduction: This review provides a summary of the medical and surgical care available to transgender individuals, as well as to offer proposals on how the medical field can progress to provide medically and culturally appropriate care.
Areas covered: Transgender individuals are defined as those whose gender identity differs from that recorded at birth (usually based on visualization of their external sexual anatomy). In order to align the body with the patient’s gender identity, clinicians can provide hormone therapy (HT) either to suppress endogenous sex hormone secretion, to bring sex hormone levels to the range associated with the patient’s gender identity, or both. Once at steady-state, regular monitoring for maintenance of levels, as well as for known risks and complications, is required. The treating clinicians should have knowledge of trans assessment criteria, hormone therapy, surgical options, primary care, and mental health needs of transgender patients. A narrative literature review was conducted using Pubmed and EMBASE with articles then selected for relevance. The following search terms were used initially: androgen suppression, antiandrogen, breast development, chest reconstruction, cisgender, estrogen, fertility preservation, gender-affirming surgery, gender identity, gender incongruence, genital reconstruction, hormone replacement, hyperlipidemia, orchiectomy, prolactin, prostate atrophy, spermatogenesis, spironolactone, testosterone, thrombogenesis, transgender, and virilization.
Expert opinion: Although guidelines exist and examples of high-quality training are readily available, to truly mainstream appropriate high-quality gender-affirming health care there must be a move towards implementing systematic formal training.
Article highlights
• Hormone therapy for transgender men includes testosterone administration to stimulate physical changes consistent with the patient’s gender identity
• Hormone therapy for transgender women includes estrogen and androgen-suppressing agents to stimulate physical changes consistent with the patient’s gender identity
• Associated risks with these therapies must be considered, and routine monitoring dependent on the specific therapy administered is recommended
• In addition to hormone therapy, there are several surgical options available for both transgender men and women to supplement hormone replacement therapy in optimizing these physical changes
• A multi-disciplinary team approach is required to tailor therapy to the individual in achieving their gender identity goals
• Advancement in the management of transgender individuals requires an intentional effort to include training for all providers
2. Hormone regimens for transgender men
2.1 Treatment effects
2.2 Medical risks/safety
2.3 Monitoring
3. Hormone regimens for transgender women
3.1 Treatment effects
3.2 Medical risks/safety
3.3 Monitoring
4. Surgical options
5. Expert Opinion
5.1 Advancement in the medical management of transgender individuals requires an intentional effort to include training for all providers
