The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair. Owing to the lack of evidence, treatment of gender nonbinary people should be individualized.
Do transgender patients require specialist care?
Transgender people have the same health care needs as cisgender people, such as basic physical exams, preventive care, and STD testing. But you may also have special health care concerns and needs. If you wish to transition medically by using hormones or having surgery, expert care is needed to avoid problems.
Does health insurance cover transgender care?
Medicare provides health insurance to millions of older and disabled Americans. Medicare provides for transgender healthcare such as routine medically necessary care, hormone replacement therapy and gender reassignment surgeries.
Why is transgender health care primary care?
Transgender individuals require health care that addresses their unique health concerns, including transition-related medical procedures and mental health (1). Poor health outcomes are disproportionately experienced by transgender individuals, and certain socio-economic factors can increase the likelihood of poor health outcomes (2-5).
What kind of tests does an endocrinologist do?
The tests an endocrinologist orders are designed to diagnose hormone-related diseases ranging from diabetes to osteoporosis. Patients with diabetes have above-normal levels of blood sugar and difficulty converting food to energy. An endocrinologist uses three tests to diagnose diabetes.
Do Endocrinologists treat transgender patients?
Endocrinologists—specialists who untangle complex symptoms to diagnose, treat, research or cure hormone-related conditions—play a key role in treating transgender individuals, but a broader healthcare team is needed to provide mental health services and other treatments, such as gender-affirmation surgery.
Which hormone is responsible for transgender?
Exogenous testosterone is used in transgender men to induce virilization and suppress feminizing characteristics. In transgender women, exogenous estrogen is used to help feminize patients, and anti-androgens are used as adjuncts to help suppress masculinizing features.
What does hormone therapy do for transgender?
Feminizing hormone therapy helps male-to-female transgender individuals (transwomen) achieve a more feminine appearance. It uses anti-androgens to block male hormones. Taking estrogen and progestin helps you develop breasts, softer skin, rounder hips and more.
Is there medical treatment for gender dysphoria?
Medical treatment of gender dysphoria might include: Hormone therapy, such as feminizing hormone therapy or masculinizing hormone therapy. Surgery, such as feminizing surgery or masculinizing surgery to change the chest, external genitalia, internal genitalia, facial features and body contour.
Is transgender hormonal imbalance?
"We've now put to rest the residual belief that transgender experience is a result of a hormone imbalance," said Dr. Johanna Olson, of Children's Hospital Los Angeles. "It's not."
Can a man have female hormones?
Estrogen is known as the “female” hormone. Testosterone is known as the “male” hormone. Although each hormone is identified with a specific sex, both are found in women and men....Normal estrogen levels in men.EstroneEstradiolPubescent maleUndetectable–60 pg/mlUndetectable–40 pg/mlAdult male10–60 pg/ml10–40 pg/ml1 more row•Oct 22, 2019
How do you transition from male to female?
Surgical optionsbreast implants.orchiectomy, which is the removal of the testicles.laser hair removal.tracheal shave, a process where the Adam's apple is made smaller.facial feminization surgery.penile inversion vaginoplasty, which is the creation of a vagina from the skin of the penis.
Does estrogen increase breast size?
When the ovaries start to produce and release (secrete) estrogen, fat in the connective tissue starts to collect. This causes the breasts to enlarge. The duct system also starts to grow.
How is hormone therapy done?
Hormone therapy can be given in a few ways: Oral medication – Taken by mouth. Injection – Given by an injection under the skin (subcutaneous) or in the muscle (intramuscular). Surgical intervention – Removal of the ovaries in women, or testicles in men, causes lower levels of hormones being made.
What are the 76 genders?
The following are some gender identities and their definitions.Agender. A person who is agender does not identify with any particular gender, or they may have no gender at all. ... Androgyne. ... Bigender. ... Butch. ... Cisgender. ... Gender expansive. ... Genderfluid. ... Gender outlaw.More items...•
How does MTF deal with gender dysphoria?
1. Express your feelings - share your feelings in a notebook or blog, or express how you feel through an art, craft or music project. 2. Talk to someone who understands - talk to a supportive friend, find an online trans community you feel connection with, or speak to QLife (qlife.org.au to webchat or 1800 184 527).
What age can you start hormone therapy?
If used in an adolescent, hormone therapy typically begins at age 16. Ideally, treatment starts before the development of secondary sex characteristics so that teens can go through puberty as their identified gender. Many trans girls are treated with a medication to delay the start of puberty.
What is the endocrine treatment for transgender adolescents?
The endocrine treatment of transgender adolescents consists of two phases: pubertal suspension or gonadal suppression followed by the addition of hormones. During the first phase, pubertal development is halted and adolescents can further explore their gender identity and prepare for the next phase.
Why do transgender women need hormones?
Transgender women seek hormone therapy to change their physical appearance to better match their gender identity and expression ( 40, 41 ). Furthermore, transgender women experience improved quality of life and a decrease in gender dysphoria upon initiation of hormone therapy ( 42, 43 ). In the United States, Canada, and most of Europe, transgender women must seek medical professionals for hormone therapy because these medications are available only by prescription, but there is a black market also particularly for oral contraceptives. For non-Western countries, hormone therapy is often self-prescribed without supervision by a medical professional. Available evidence from the United States and Europe suggests that hormone therapy initiated and monitored under the supervision of a medical professional is associated with very low rates of adverse events ( 44, 45 ).
How does estrogen affect transgender women?
Treatment with estrogen and testosterone-lowering medications will induce feminine and reduce masculine physical characteristics Fig. 1 ( 41 ). The most studied physical change in transgender women is the development of breast tissue. An Italian cohort study found increases in breast size were the only physical feature that was significantly associated with improvement in body uneasiness scores ( 43 ). However, <20% of transgender women reach Tanner breast stage 4 to 5 after 24 months of hormone therapy and thus often seek mammoplasty. Early studies in transgender women indicated breast development reached a maximum size by 2 years ( 74 ). However, a more recent study of 229 transgender women participating in the European Network for the Investigation of Gender Incongruence cohort found that breast development reached a plateau within the first 6 months of therapy and half of the transgender women had a AAA cup size or less ( 75 ). Fisher et al. ( 43) also found that testicular volume decreased by ~60% after 24 months of transfeminine hormone therapy.
How does hormone therapy affect mental health?
A number of longitudinal studies have explored the role of hormonal treatment in mental health and quality of life among transgender people wanting gender-affirmation treatment. These studies, which have mainly been conducted in Europe [Sweden ( 34 ), Italy ( 35 ), Belgium ( 36 ), and Germany ( 37 )], have all demonstrated that people’s mental health (levels of depression and anxiety) significantly improved following hormone treatment. Long-term follow-up studies and studies involving large groups of people are needed to evaluate whether these improvements remain. Hence, hormone treatment of those wanting physical change needs to be accessible, as this will reduce morbidity and improve quality of life of transgender people.
How many studies have been done to investigate transgender people?
More than 20 studies have sought to investigate prevalence rates of transgender people. Although more recently prevalence rates of transgender identities have been reported using population studies, most of the available literature has extrapolated prevalence rates from people attending transgender health clinics ( 7 ).
What is gender dysphoria?
Gender dysphoria refers to a profound distress or discomfort caused by the discrepancy between a person’s assigned sex at birth and gender identity (1). Not every transgender person suffers from gender dysphoria, and the urgency for medical intervention among transgender people may vary (1).
What is a cisgender?
Cisgender:A person whose identity matches the sex assigned at birth. Gender-affirming treatment:Physical treatment that some transgender people access in order for their bodies to be adapted to the bodies of their experienced gender or gender identity by means of hormones and/or surgery.
What is sex reassignment?
Sex reassignment is a multidisciplinary treatment. It re-quires five processes: diagnostic assessment, psychotherapyor counseling, RLE, hormone therapy, and surgical therapy.The focus of this Guideline is hormone therapy, althoughcollaboration with appropriate professionals responsible foreach process maximizes a successful outcome. It would beideal if care could be given by a multidisciplinary team at onetreatment center, but this is not always possible. It is essentialthat all caregivers be aware of and understand the contribu-tions of each discipline and that they communicate through-out the process.
What is the clinical guidelines subcommittee?
The Clinical Guidelines Subcommittee of The EndocrineSociety deemed the diagnosis and treatment of transsexualindividuals a priority area in need of practice guidelinesand appointed a Task Force to formulate evidence-basedrecommendations. The Task Force followed the approachrecommended by the Grading of Recommendations, As-sessment, Development, and Evaluation (GRADE) group,an international group with expertise in development andimplementation of evidence-based guidelines (19). A de-tailed description of the grading scheme has been pub-lished elsewhere (20). The Task Force used the best avail-able research evidence that Task Force members identifiedand two commissioned systematic reviews (21, 22) to de-velop some of the recommendations. The Task Force alsoused consistent language and graphical descriptions ofboth the strength of a recommendation and the quality ofevidence. In terms of the strength of the recommendation,strong recommendations use the phrase “we recommend”and the number 1, and weak recommendations use thephrase “we suggest” and the number 2. Cross-filled circlesindicate the quality of the evidence, such that de-QEEEnotes very low quality evidence, denotes low qual-QQEEity,QQQEdenotes moderate quality, andQQQQdenoteshigh quality. The Task Force has confidence that personswho receive care according to the strong recommenda-tions will derive, on average, more good than harm. Weakrecommendations require more careful consideration ofthe person’s circumstances, values, and preferences to de-termine the best course of action. Linked to each “recom-mendation” is a description of the “evidence” and the“values” that panelists considered in making the recom-mendation; in some instances, there are “remarks,” a sec-tion in which panelists offer technical suggestions for test-ing conditions, dosing, and monitoring. These technicalcomments reflect the best available evidence applied to atypical person being treated. Often this evidence comesfrom the unsystematic observations of the panelists andtheir values and preferences; therefore, these remarksshould be considered suggestions. Some statements in thisguideline (1.3 and 1.4) are not graded. These are state-ments the task force felt it was necessary to make, and itconsiders them matters about which no sensible health-care professional could possibly consider advocating thecontrary (e.g. clinicians should conduct an adequate his-tory taking and physical examination, clinicians shouldeducate patients about their condition). These statementshave not been subject to structured review of the evidenceand are thus not graded.
Does es-tradiol affect BMD?
Studies in aging genetic males suggest that serum es-tradiol more positively correlates with BMD than doestestosterone (117–119) and is more important for peakbone mass (120). Estrogen preserves BMD in MTF trans-sexuals who continue on estrogen and antiandrogen ther-apies (116, 121, 122).
Should endocrine patients be informed of cross-sex hormones?
All endocrine-treated individuals should be informedof all risks and benefits of cross-sex hormones before ini-tiation of therapy. Cessation of tobacco use should bestrongly encouraged in MTF transsexual persons to avoidincreased risk of thromboembolism and cardiovascularcomplications.
Is MTF more complex than FTM?
The hormone regimen for MTF transsexual individualsis more complex than the FTM regimen. Most publishedclinical studies report the use of an antiandrogen in con-junction with an estrogen (80, 82– 84, 89).
Is breast cancer a concern for transgender women?
Breast cancer is a concern in transsexual women . A fewcases of breast cancer in MTF transsexual persons havebeen reported in the literature (123–125). In the Dutchcohort of 1800 transsexual women followed for a mean of
What is transgender woman?
Lauren Schlanger, MD. Updated on June 14, 2021. Transgender women and transfeminine people are people whose assigned sex at birth is male, yet they exist as women. Transgender people represent a group that includes not just transgender women but also non-binary people who have a more feminine gender identity than the one ...
Why is oral ethinyl estradiol not recommended for transgender women?
Oral ethinyl estradiol is not recommended for use in transgender women because it is associated with an increased risk of blood clots. Conjugated estrogens are not used frequently, as they may put women at a higher risk of blood clots and heart attacks than 17B-estradiol, and they also cannot be accurately monitored with blood tests.
Why do transfeminine people have testicles removed?
1 . The purpose of estrogen treatment for transfeminine people is to cause physical changes that make the body more feminine.
How much estrogen should I take for premenopausal women?
The goal is to make certain you have similar levels of estrogen to premenopausal cisgender women, which is about 100 to 200 picograms/milliliter (pg/mL). A doctor will also need to monitor the effects of your anti-androgen by checking your testosterone levels.
What happens when you take estrogen and testosterone blocker?
The combination of a testosterone blocker with estrogen can lead to the following types of desired changes in the body: breast growth. decreased body and facial hair. redistribution of body fat. softening and smoothing of the skin. reduced acne. slowed or stopped scalp balding 1 .
Do transgender women need the same screening tests as cisgender women?
Transgender women and non-binary feminine people taking estrogen treatment should be aware that they will need many of the same screening tests as cisgender women. In particular, they should follow the same screening guidelines for mammograms.
Do transgender women need to be screened for prostate cancer?
On the other hand, transgender women and feminine people on estrogen don't need to be screened for prostate cancer until after they turn 50.
When can transgender people start hormone therapy?
Transgender adolescents usually have stable gender identities and can be given GnRH analogs to suppress puberty until they can proceed with hormone therapy as early as age 16.
What is the normal testosterone level for transgender men?
A practical target for hormone therapy for transgender men (FTM) is to increase testosterone levels to the normal male physiological range (300–1000 ng/dl) by administering testosterone.
How long after parenteral testosterone injection can you measure peak?
Peak levels for patients taking parenteral testosterone can be measured 24 – 48 h after injection. Trough levels can be measured immediately before injection.
When to monitor hematocrit and lipid profile?
Monitor hematocrit and lipid profile before starting hormones and at follow-up visits.
Should MTF patients be screened for breast cancer?
MTF patients should be screened for breast and prostate cancer appropriately.
