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I received messages fr people asking abt transition therapy for transgender males & females. Recently I had a patient who is using hormones w/o medical supervision.
Transgender transition for gender-incongruent people: A thread for transgender brothers and sisters.
Transgender transition for gender-incongruent people: A thread for transgender brothers and sisters.
DISCLAIMERThis thread is for information and educational purposes only and does not and will not replace a consult with a physician. No patient-doctor relationship will be established between me and the reader of this thread.
Gender affirmation is the treatment (Tx) procedure for people who want to adapt their bodies to their gender identity. It is a science-based approach that aims to suppress natural sex hormones & maintain sex hormone
levels w/n the normal range for the person’s experienced gender.
levels w/n the normal range for the person’s experienced gender.
It is a multidisciplinary approach that involves:
1. Psychiatry- confirm presence of gender incongruence & manage coexisting conditions such as depression
2. Endocrinology- guided hormone Tx & monitoring
3. Surgery- for gender reassignment procedures
1. Psychiatry- confirm presence of gender incongruence & manage coexisting conditions such as depression
2. Endocrinology- guided hormone Tx & monitoring
3. Surgery- for gender reassignment procedures
Before a person undergoes hormone Tx, a person should be seen by a mental health professional (psychiatrist) to see if a person meets the criteria for gender incongruence, and assess mental health & social conditions that may impact therapy.
Being a transgender is NOT a psychological disorder. But guidance of a mental health professional is necessary to manage any co-existing mental health issues. The most common cause of death of transgender people is not the side effects of hormones but suicide from depression.
Criteria for transsexualism
Desire to live & be accepted as a member of the
opposite sex, w/ the wish to make the body congruent w/ the preferred sex thru surgery & hormones
The transsexual identity is present at least 2 yrs
The condition is not a symptom of other disoders
Desire to live & be accepted as a member of the opposite sex, w/ the wish to make the body congruent w/ the preferred sex thru surgery & hormones
The transsexual identity is present at least 2 yrsThe condition is not a symptom of other disoders
Once a person is confirmed to have gender incongruence & wants to transition, an endocrinologist prescribes the hormones with the right dose and monitor and educate about possible side effects.
Criteria for hormone Tx
Persistent, well-documented gender dysphoria/gender incongruence
The capacity to make a fully informed decision & to consent for Tx
The age of majority in a given country
Mental health concerns, if present, must be reasonably well controlled
Persistent, well-documented gender dysphoria/gender incongruenceThe capacity to make a fully informed decision & to consent for TxThe age of majority in a given countryMental health concerns, if present, must be reasonably well controlled
CAVEAT!
NEVER use estrogen or testosterone without medical guidance.
Use of ethynyl estradiol is not the preferred Tx for transgender females bc it is associated with pulmonary embolism (blockage of blood vessels going to the lungs, can be deadly.)
NEVER use estrogen or testosterone without medical guidance.
Use of ethynyl estradiol is not the preferred Tx for transgender females bc it is associated with pulmonary embolism (blockage of blood vessels going to the lungs, can be deadly.)
Other possible side effects:
Estrogen Tx
Breast Cancer, heart disease, stroke, gall stones and high triglycerides
Testosterone Tx:
Erythocytosis (high red blood cells), liver problem, heart problem, hypertension, stroke.
Estrogen Tx
Breast Cancer, heart disease, stroke, gall stones and high triglycerides
Testosterone Tx:
Erythocytosis (high red blood cells), liver problem, heart problem, hypertension, stroke.
The above side effects can be prevented by medical supervision, by using the appropriate hormone dose, and by following screening procedures or tests to detect these. Therapy can be safe if supervised medically but may be DANGEROUS without supervision.
Endocrinologists monitor BP, CBC, bone health, cancer risk, blood sugar, liver enzymes, cholesterol levels etc.
SMOKING while on hormone therapy is STRONGLY DISCOURAGED as it may increase lung and heart problems.
SMOKING while on hormone therapy is STRONGLY DISCOURAGED as it may increase lung and heart problems.
When starting hormone therapy transgender individuals should also manage expectations and BE PATIENT when it comes to the desired effects of therapy. It will take weeks or even months for the changes in the body. Never increase your dose on your own!
When an individual is successful with hormone Tx and desires gender-affirming surgery a person must be screened by a mental health professional and an endocrinologist for appropriateness and safety.
This thread DOES NOT apply to the pediatric or prepubertal population.
SUMMARY:
1. Gender affirming Tx requires a psychiatrist, endocrinologist, and if necessary, a surgeon.
2. The risk of hormone therapy can be minimized by appropriate dose and monitoring by your endocrinologist.
3. NEVER use hormones without medical supervision.
1. Gender affirming Tx requires a psychiatrist, endocrinologist, and if necessary, a surgeon.
2. The risk of hormone therapy can be minimized by appropriate dose and monitoring by your endocrinologist.
3. NEVER use hormones without medical supervision.
Reference: Endocrine Treatment of Gender-Dysphoric/
Gender-Incongruent Persons: An Endocrine Society*
Clinical Practice Guideline. J Clin Endocrinol Metab, November 2017, 102(11):3869–3903.
Gender-Incongruent Persons: An Endocrine Society*
Clinical Practice Guideline. J Clin Endocrinol Metab, November 2017, 102(11):3869–3903.
