TRANSGENDER TRANSITIONING AND TREATMENT:
Transgender people may seek any one of a number of gender affirming interventions, including hormone therapy, surgery, facial hair removal, interventions for the modification of speech and communication, and behavioral adaptations such as genital tucking or packing, or chest binding. The World Professional Association (WPATH) has defined all of these procedures as medically necessary for Transgender Health. The current standard of care is to allow each transgender person to seek only those interventions that they desire to affirm their own gender identity
Gender affirming hormone therapy is the primary medical intervention sought by transgender people. Such treatment allows the achievement of secondary sex characteristics more aligned with an individual's gender identity.
Endocrinologists recommend appropriate hormone therapy for transgender persons who want to develop the physical characteristics of their desired gender. The therapy objective seeks to:
• Suppress the production of hormones that are determined by the person’s genetic sex
• Maintain “cross-sex” hormone levels within the normal range for the person’s desired gender
* When should endocrine treatment of transgender persons begin? Individuals seeking endocrine treatment must first be diagnosed with GID by a mental health professional, and undergo psychotherapy or counseling and a “real-life experience.” The real-life experience is a year-long period during which the person lives full-time in the desired gender role before starting irreversible physical treatment. On occasion, the real life experience runs parallel with medical treatment rather than preceding it. Neither a complete social role change nor hormone treatment is recommended before the onset of puberty, since GID in children often does not continue into adolescence.
* How is hormone therapy used in transgender adults?
Female-to-male (FTM) transsexual persons Several different androgen preparations can be used to develop masculine characteristics in FTM transsexual adults. Injections, skin gels, or patches can be used to bring testosterone levels in the body into the normal male range. Testosterone treatment results in increased muscle mass, decreased fat mass, increased facial hair and acne, and increased libido (sex drive). Testosterone treatment may also result in enlargement of the clitoris, decreased fertility, deepening voice, and, usually, the end of menstruation. Menstruation may stop within a few months with testosterone treatment alone, although high doses may be needed. GnRH analogues or progesterone may also be used to stop menstruation before testosterone treatment and to reduce estrogens to the levels found in biological males.
Male-to-female transgender (MTF) persons Cross-sex hormone therapy for MTF transgender adults requires the use of an anti-androgen along with an estrogen. For estrogen therapy to have its fullest effect, the MTF person’s testosterone levels need to be reduced to levels typically found in biological women. Both the anti-androgen spironolactone and GnRH agonists are effective in reducing testosterone levels. Estrogen is available as a pill, a skin gel, a patch, or an injection. The MTF person’s blood level of estrogen should be maintained at the average level for premenopausal women, and the testosterone level should be in the female range.
* What are the risks of hormone therapy and how can they be avoided? Cross-sex hormone therapy has the same risks as sex hormone replacement therapy in biological males and females. Pretreatment screening and regular medical monitoring are recommended for both FTM and MTF transgender persons. The guidelines recommend monitoring every 3 months during the first year of hormone therapy and then once or twice yearly
It is imperative that the transgender person understands the effects of hormone suppression and cross-sex hormone treatment prior to initiating endocrine therapy. In particular, ask about its effects on fertility and about available options that may improve the chances of future fertility, if that is a concern for you. It is imperative that you follow the physician recommended regimen and maintain regularly scheduled physician recommended testing and monitoring of your condition.