Transgender Hormones

Transgender Hormones




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Transgender Hormones







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^ Jump up to: a b Estimates represent published and unpublished clinical observations.

^ Time at which further changes are unlikely at maximum maintained dose. Maximum effects vary widely depending on genetics , body habitus , age , and status of gonad removal . Generally, older individuals with intact gonads may have less feminization overall.

^ Complete removal of male facial and body hair requires electrolysis , laser hair removal , or both. Temporary hair removal can be achieved with shaving , epilating , waxing , and other methods.

^ Familial scalp hair loss may occur if estrogens are stopped.

^ Varies significantly depending on the amount of physical exercise .

^ Occurs only in individuals of pubertal age who have not yet completed epiphyseal closure .

^ Additional research is needed to determine permanency, but a permanent impact of estrogen therapy on sperm quality is likely and sperm preservation options should be counseled on and considered before initiation of therapy.

^ Conflicting reports, with none reported observed in transgender women but significant albeit minor reduction of penis size reported in men with prostate cancer on androgen deprivation therapy . [16] [17] [18] [19]

^ Treatment by speech pathologists for voice training is effective.



^ Ferguson, Joshua M. (November 30, 2017). "What It Means to Transition When You're Non-Binary" . Teen Vogue .

^ Jump up to: a b Deutsch MB, Feldman JL. Updated recommendations from the world professional association for transgender health standards of care. Am Fam Physician. 2013 Jan 15;87(2):89-93.

^ Jump up to: a b UCSF Transgender Care, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016. Available at transcare.ucsf.edu/guidelines.

^ Schreiber, Leslie. "Howard Brown Health Center Establishes Transgender Hormone Protocol" . www.howardbrown.org . Howard Brown. Archived from the original on 2011-10-08 . Retrieved 2011-08-25 .

^ "What Health Care & Services Do Transgender People Require?" . www.plannedparenthood.org . Retrieved 2019-10-16 .

^ Jump up to: a b c d e f g h i j k Coleman, Eli; et al. (August 2012). "Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7" . International Journal of Transgenderism . 13 (4): 165–232. doi : 10.1080/15532739.2011.700873 . S2CID 39664779 .

^ "Gender dysphoria" . nhs.uk . 2017-10-23 . Retrieved 2021-11-15 .

^ Unger, Cécile A. (December 2016). "Hormone therapy for transgender patients" . Translational Andrology and Urology . 5 (6): 877–884. doi : 10.21037/tau.2016.09.04 . ISSN 2223-4691 . PMC 5182227 . PMID 28078219 .

^ "Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People | Transgender Care" . transcare.ucsf.edu . Retrieved 2021-05-13 .

^ Emmanuel, Mickey; Bokor, Brooke R. (2021), "Tanner Stages" , StatPearls , Treasure Island (FL): StatPearls Publishing, PMID 29262142 , retrieved 2021-11-12

^ Jump up to: a b Bangalore Krishna, Kanthi; Fuqua, John S.; Rogol, Alan D.; Klein, Karen O.; Popovic, Jadranka; Houk, Christopher P.; Charmandari, Evangelia; Lee, Peter A. (2019). "Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium" . Hormone Research in Paediatrics . 91 (6): 357–372. doi : 10.1159/000501336 . ISSN 1663-2818 . PMID 31319416 . S2CID 197664792 .

^ "Hormone Use for Non-Binary People | GenderGP" . GenderGP.com . Retrieved 2020-10-18 .

^ Jump up to: a b "Information on Estrogen Hormone Therapy | Transgender Care" . transcare.ucsf.edu . Retrieved 2019-08-07 .

^ Jump up to: a b "Overview of feminizing hormone therapy | Gender Affirming Health Program" . transcare.ucsf.edu . Retrieved 2021-11-12 .

^ "Overview of feminizing hormone therapy | Gender Affirming Health Program" . transcare.ucsf.edu . Retrieved 2021-11-16 .

^ Elliott S, Latini DM, Walker LM, Wassersug R, Robinson JW (September 2010). "Androgen deprivation therapy for prostate cancer: recommendations to improve patient and partner quality of life". J Sex Med . 7 (9): 2996–3010. doi : 10.1111/j.1743-6109.2010.01902.x . PMID 20626600 .

^ Higano CS (February 2003). "Side effects of androgen deprivation therapy: monitoring and minimizing toxicity". Urology . 61 (2 Suppl 1): 32–8. doi : 10.1016/S0090-4295(02)02397-X . PMID 12667885 .

^ Higano CS (October 2012). "Sexuality and intimacy after definitive treatment and subsequent androgen deprivation therapy for prostate cancer". J. Clin. Oncol . 30 (30): 3720–5. doi : 10.1200/JCO.2012.41.8509 . PMID 23008326 .

^ Eberhard Nieschlag; Hermann Behre (29 June 2013). Andrology: Male Reproductive Health and Dysfunction . Springer Science & Business Media. pp. 54–. ISBN 978-3-662-04491-9 .

^ Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline" (PDF) . J. Clin. Endocrinol. Metab . 102 (11): 3869–3903. doi : 10.1210/jc.2017-01658 . PMID 28945902 . S2CID 3726467 .

^ Coleman, E.; Bockting, W.; Botzer, M.; Cohen-Kettenis, P.; DeCuypere, G.; Feldman, J.; Fraser, L.; Green, J.; Knudson, G.; Meyer, W. J.; Monstrey, S.; Adler, R. K.; Brown, G. R.; Devor, A. H.; Ehrbar, R.; Ettner, R.; Eyler, E.; Garofalo, R.; Karasic, D. H.; Lev, A. I.; Mayer, G.; Meyer-Bahlburg, H.; Hall, B. P.; Pfaefflin, F.; Rachlin, K.; Robinson, B.; Schechter, L. S.; Tangpricha, V.; van Trotsenburg, M.; Vitale, A.; Winter, S.; Whittle, S.; Wylie, K. R.; Zucker, K. (2012). "Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7" (PDF) . International Journal of Transgenderism . 13 (4): 165–232. doi : 10.1080/15532739.2011.700873 . ISSN 1553-2739 . S2CID 39664779 .

^ Bourns, Amy (2015). "Guidelines and Protocols for Comprehensive Primary Care for Trans Clients" (PDF) . Sherbourne Health Centre . Retrieved 15 August 2018 .

^ Fabris B, Bernardi S, Trombetta C (March 2015). "Cross-sex hormone therapy for gender dysphoria". J. Endocrinol. Invest . 38 (3): 269–82. doi : 10.1007/s40618-014-0186-2 . PMID 25403429 . S2CID 207503049 .

^ Moore E, Wisniewski A, Dobs A (August 2003). "Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects" . The Journal of Clinical Endocrinology and Metabolism . 88 (8): 3467–73. doi : 10.1210/jc.2002-021967 . PMID 12915619 .

^ Asscheman, Henk; Gooren, Louis J.G. (1993). "Hormone Treatment in Transsexuals". Journal of Psychology & Human Sexuality . 5 (4): 39–54. doi : 10.1300/J056v05n04_03 . ISSN 0890-7064 .

^ Levy A, Crown A, Reid R (October 2003). "Endocrine intervention for transsexuals". Clin. Endocrinol. (Oxf) . 59 (4): 409–18. doi : 10.1046/j.1365-2265.2003.01821.x . PMID 14510900 . S2CID 24493388 .

^ de, Blok Christel; Klaver, Maartje; Nota, Nienke; Dekker, Marieke; den, Heijer Martin (2016). "Breast development in male-to-female transgender patients after one year cross-sex hormonal treatment". Endocrine Abstracts . doi : 10.1530/endoabs.41.GP146 . ISSN 1479-6848 .

^ de Blok CJ, Klaver M, Wiepjes CM, Nota NM, Heijboer AC, Fisher AD, Schreiner T, T'Sjoen G, den Heijer M (February 2018). "Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study" . J. Clin. Endocrinol. Metab . 103 (2): 532–538. doi : 10.1210/jc.2017-01927 . PMID 29165635 . S2CID 3716975 .

^ "Masculinizing hormone therapy - Mayo Clinic" . www.mayoclinic.org . Retrieved 2019-08-02 .

^ Jump up to: a b c "Information on Testosterone Hormone Therapy | Transgender Care" . transcare.ucsf.edu . Retrieved 2019-08-07 .

^ "Overview of masculinizing hormone therapy | Gender Affirming Health Program" . transcare.ucsf.edu . Retrieved 2021-11-12 .

^ Weinand, J. D.; Safer, J. D. (June 2015). "Weinand J, Safer J. Feb 2015. "Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals." Journal of Clinical & Translational Endocrinology (2015)" . Journal of Clinical & Translational Endocrinology . 2 (2): 55–60. doi : 10.1016/j.jcte.2015.02.003 . PMC 5226129 . PMID 28090436 .

^ Task Force on Oral Contraceptives; Koetsawang, Suporn; Mandlekar, A.V.; Krishna, Usha R.; Purandare, V.N.; Deshpande, C.K.; Chew, S.C.; Fong, Rosilind; Ratnam, S.S.; Kovacs, L.; Zalanyi, S. (May 1980). "A randomized, double-blind study of two combined oral contraceptives containing the same progestogen, but different estrogens". Contraception . 21 (5): 445–459. doi : 10.1016/0010-7824(80)90010-4 . ISSN 0010-7824 . PMID 7428356 .

^ Jump up to: a b TʼSjoen, Guy; Van Caenegem, Eva; Wierckx, Katrien (2013). "Transgenderism and reproduction". Current Opinion in Endocrinology, Diabetes and Obesity . 20 (6): 575–579. doi : 10.1097/01.med.0000436184.42554.b7 . ISSN 1752-2978 . PMID 24468761 . S2CID 205398449 .

^ Jump up to: a b De Sutter, P. (2001). "Gender reassignment and assisted reproduction: present and future reproductive options for transsexual people". Human Reproduction (Oxford, England) . 16 (4): 612–614. doi : 10.1093/humrep/16.4.612 . ISSN 0268-1161 . PMID 11278204 .

^ "Ovary function is preserved in transgender men at one year of testosterone therapy | Endocrine Society" . www.endocrine.org . Retrieved 2019-03-25 . {{ cite web }} : CS1 maint: url-status ( link )

^ "CORRIGENDUM FOR "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline" " . The Journal of Clinical Endocrinology & Metabolism . 103 (7): 2758–2759. 2018-07-01. doi : 10.1210/jc.2018-01268 . ISSN 0021-972X . PMID 29905821 .

^ "ICD-10 Diagnostic Codes" . ICD-10:Version 2010 . Retrieved 2014-06-08 .

^ Jump up to: a b American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5th ed.). Washington, DC and London: American Psychiatric Publishing. pp. 451–460 . ISBN 978-0-89042-555-8 .

^ Hembree, Wylie, C; Cohen-Kettenis, Peggy; Delemarre-van de Waal, Henriette; Gooren, Louis; Meyer III, Walter; Spack, Norman; Tangpricha, Vin; Montori, Victor (September 2009). "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline" . The Journal of Clinical Endocrinology & Metabolism . 94 (9): 3132–54. doi : 10.1210/jc.2009-0345 . PMID 19509099 .

^ Bornstein, Kate (2013). My Gender Workbook, Updated : How to Become a Real Man, a Real Woman, the Real You, or Something Else Entirely (2nd ed.). New York: Routledge. ISBN 978-0415538657 .

^ "Gender-Affirming Hormone Therapy 101: Introducing the #HRTSavesLives Campaign" . 10 August 2020.

^ "Survey of Patient Satisfaction with Transgender Services" (PDF) . Archived from the original (PDF) on 2016-03-04 . Retrieved 2016-01-08 .

^ Becerra Fernández A, de Luis Román DA, Piédrola Maroto G (October 1999). "Morbilidad en pacientes transexuales con autotratamiento hormonal para cambio de sexo" [Morbidity in transsexual patients with cross-gender hormone self-treatment] (PDF) . Med Clin (Barc) (in Spanish). 113 (13): 484–7. ISSN 0025-7753 . PMID 10604171 .



# WHO-EM
‡ Withdrawn from market
Clinical trials :
† Phase III
§ Never to phase III


# WHO-EM
‡ Withdrawn from market
Clinical trials :
† Phase III
§ Never to phase III


# WHO-EM
‡ Withdrawn from market
Clinical trials :
† Phase III
§ Never to phase III


# WHO-EM
‡ Withdrawn from market
Clinical trials :
† Phase III
§ Never to phase III

Transgender hormone therapy , also called hormone replacement therapy ( HRT ) or gender-affirming hormone therapy ( GAHT ), is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity . This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization :

Some intersex people may also undergo hormone therapy, either starting in childhood to confirm the sex they were assigned at birth , or later in order to align their sex with their gender identity. Non-binary people may also engage in hormone therapy in order to achieve a desired balance of sex hormones or to help align their bodies with their gender identities. [1]

The formal requirements to begin gender-affirming hormone therapy vary widely depending on geographic location and specific institution. Gender affirming hormones can be prescribed by a wide range of medical providers including, but not limited to, primary care physicians, endocrinologists, and obstetrician-gynecologists. [2]

Historically, many health centers required a psychiatric evaluation and/or a letter from a therapist before beginning therapy. Many centers now use an informed consent model that does not require any routine formal psychiatric evaluation but instead focuses on reducing barriers to care by ensuring a person can understand the risks, benefits, alternatives, unknowns, limitations, and risks of no treatment. [3] Some LGBT health organizations (notably Chicago's Howard Brown Health Center [4] and Planned Parenthood [5] ) advocate for this type of informed consent model.

The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC) require that patients seeking gender-affirmation hormone therapy be evaluated for gender dysphoria by either a mental health professional or hormone provider who is qualified in the area of transgender care. The Standards also require that the patient give informed consent , in other words, that they consent to the treatment after being fully informed of the risks involved. [6] Before beginning gender-affirming hormone therapy, the patient must be evaluated for significant medical and mental health concerns. If present, these must be addressed and reasonably well-controlled. [6]

The World Professional Association for Transgender Health (WPATH) Standards of Care, 7th edition, note that both of these approaches to care are appropriate. [2]

Many international guidelines and institutions require persistent, well-documented gender dysphoria as a pre-requisite to starting gender-affirmation therapy. Gender dysphoria refers to the psychological discomfort or distress that an individual can experience if their sex assigned at birth is incongruent with that person's gender identity. [6] Signs of gender dysphoria can include comorbid mental health stressors such as depression, anxiety, low self-esteem, and social isolation. [7] It is important to note that not all gender nonconforming individuals experience gender dysphoria. [ citation needed ]

The World Professional Association for Transgender Health (WPATH) and the Endocrine Society formulated guidelines that created a foundation for health care providers to care for transgender patients. [8] UCSF guidelines are also used. [9] [ citation needed ] There is no generally agreed-upon set of guidelines, however. [ citation needed ]

Adolescents experiencing gender dysphoria may opt to undergo puberty-suppressing hormone therapy at the onset of puberty. The Standards of Care set forth by WPATH recommend individuals pursuing puberty-suppressing hormone therapy wait until at least experiencing Tanner Stage 2 pubertal development. [6] Tanner Stage 2 is defined by the appearance of scant pubic hair, breast bud development, and/or slight testicular growth. [10] WPATH classifies puberty-suppressing hormone therapy as a "fully reversible" intervention. Delaying puberty allows individuals more time to explore their gender identity before deciding on more permanent interventions and prevents the physical changes associated with puberty. [6]

The preferred puberty-suppressing agent for both individuals assigned male at birth and individuals assigned female at birth is a GnRH Analogue. [6] This approach temporarily shuts down the Hypothalamic-Pituitary-Gonadal (HPG) Axis , which is responsible for the production of hormones (estrogen, testosterone) that cause the development of secondary sexual characteristics in puberty. [11] It is important for adolescents undergoing puberty-suppressing hormone therapy to be monitored by a medical professional. [ citation needed ]

Feminizing hormone therapy is typically used by transgender women, who desire the development of feminine secondary sex characteristics . Individuals who identify as non-binary may also opt-in for feminizing hormone treatment to better align their body with their desired gender expression. [12] Feminizing hormone therapy usually includes medication to suppress testosterone production and induce feminization . Types of medications include estrogens , antiandrogens (testosterone blockers), and progestogens . [13] Most commonly, an estrogen is combined with an antiandrogen to suppress and block testosterone. [14] This allows for demasculinization and promotion of feminization and breast development . Estrogens are administered in various modalities including injection, transdermal patch, and oral tablets. [15]

The desired effects of feminizing hormone therapy focus on the development of feminine secondary sex characteristics . These desired effects include: breast tissue development, redistribution of body fat, decreased body hair, reduction of muscle mass, and more. [14] The table below summarizes some of the effects of feminizing hormone therapy in transgender women:

Masculinizing hormone therapy is typically used by transgender men, who desire the development of masculine secondary sex characteristics. Masculinizing hormone therapy usually includes testosterone to produce masculinization and suppress the production of estrogen . [29] Treatment options include oral , parenteral , subcutaneous implant , and transdermal ( patches , gels ). Dosing is patient-specific and is discussed with the physician. [30] The most commonly prescribed methods are intramuscular and subcutaneous injections . This dosing can be weekly or biweekly depending on the individual patient. [ citation needed ]

Unlike feminizing hormone therapy, individuals undergoing masculinizing hormone therapy do not usually require additional hormone suppression such as estrogen suppression. Therapeutic doses of testosterone are usually sufficient to inhibit the production of estrogen
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