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Hormonal Therapy of the Transgender
ALEJANDRO MARTINÓ, MDENDOCRINOLOGY
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DISCLOSURES
• None
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OBJECTIVES
• Discuss the rationale of hormonal therapy in the transgender
• Discuss the hormonal regimen for Female-to-Male (FTM) transgender
• Discuss the hormonal regimen for Male-to-Female (MTF) transgender
• Discuss the hormonal regimen in the pediatric transgender
• General discussion of Gender Affirmation Surgery (GAS)/Sex Reassignment Surgery
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REFERENCES
(Harry Benjamin International Gender Dysphoria Association)
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Dr. Harry Benjamin
(January 12, 1885 – August 24, 1986)
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REFERENCES
(Harry Benjamin International Gender Dysphoria Association)
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RATIONAL OF HORMONE THERAPY IN TRANSGENDERS
• Medically necessary intervention for many transgender and gender nonconforming individuals with GENDER DYSPHORIA
• Hormone therapy can provide significant comfort to patients who do not wish to make a social gender role transition or undergo surgery, or who are unable to do so
• Some people seek maximum feminization/masculinization
• Others experience relief with an androgynous presentation resulting from hormonal minimization of existing secondary sex characteristics
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Hormone Therapy of the Transgender
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Eligibility and Readiness Criteria for Hormone Therapy
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Hormonal Regimen for Female-to-Male Transgender
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Female-to-Male Hormonal Therapy
• Similar to TESTOSTERONE REPLACEMENT THERAPY in a cis-man(non-transsexual man)
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Female-to-Male Hormonal Therapy
• Similar to TESTOSTERONE REPLACEMENT THERAPY in a cis-man
• Intramuscular preparations induces masculinizing changes faster
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Female-to-Male Hormonal Therapy
• Monitoring
• Every 2-3 months in the 1st year, then 1-2 times per year
• Serum testosterone (initially the Total Testosterone can be highSHBG)
• CBC
• LFT
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Hormonal Regimen for Male-to-Female Transgender
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Male-to-Female Hormonal Therapy
• Is more complex than the Female-to-Male regimen
• A combination of estrogen and “anti-androgens” is the most commonly studied regimen for feminization
• “Anti-androgens” minimize the dosage of estrogen needed to suppress testosterone
• Thereby reducing the risks associated with high-dose exogenous estrogen
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Male-to-Female Hormonal Therapy
• Monitoring
• Measure serum testosterone and estradiol every 3 months
• Serum testosterone levels: < 55 ng/dL
• Serum estradiol levels: < 200 pg/mL
• For individuals on spironolactone
• Serum potassium every 3 months, during the 1st year
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Hormonal Regimen in the Pediatric Transgender
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Gender Identity Disorder in Pediatric Population
• The large majority (75–80%) of prepubertal children with a diagnosis of gender identity disorder (GID) in childhood do not turn out to be transsexual in adolescence
• Clinical experience suggests that GID can be reliably assessed only after the first signs of puberty
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Pediatric Transgender Hormonal Regimen
• Suppress pubertal hormones not earlier than Tanner 2
• GnRH analogs
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Pediatric Transgender Hormonal Regimen
• Suppress pubertal hormones not earlier than Tanner 2
• GnRH analogs
• Pubertal development of the desired, opposite sex be initiated at the age of 16 y/o, using a gradually increasing dose schedule of cross-sex steroids.
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Pediatric Transgender Hormonal Regimen
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Pediatric Transgender Hormonal Regimen
• Suppress pubertal hormones not earlier than Tanner 2
• GnRH analogs
• Pubertal development of the desired, opposite sex be initiated at the age of 16 y/o, using a gradually increasing dose schedule of cross-sex steroids.
• Defer gender affirming surgery until the individual is at least 18 y/o.
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Potential Adverse Effects
•Bone mass
•Growth
• Fertility
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Gender Affirmation Surgery/Sex Reassignment Surgery
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Gender Affirmation Surgery/Sex Reassignment Surgery
• Many transgender find comfort with their gender identity, role, and expression without surgery.
• For many others, surgery is essential and medically necessary to alleviate their gender dysphoria
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Gender Affirmation Surgery/Sex Reassignment Surgery
• Overview of Surgical Procedures
• Breast/Chest surgery
• Genital surgery
• Non-genital, non-breast surgical interventions
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Thank You