Endocrine care of transpeople part II. A review of cross‐sex hormonal treatments, outcomes and adverse effects in transwomen

Abstract

The treatment of transwomen relies on the combined administration of anti-androgens or GnRH analogues to suppress androgen production and thereby reduce male phenotypic characteristics together with oestrogens to develop female characteristics. In transwomen, synthetic oestrogens such as ethinyl oestradiol, as well as conjugated equine oestrogens (CEE), should be avoided to minimize thromboembolic risks especially in older transwomen and in those with risk factors. Currently, available short- and long-term safety studies suggest that cross-sex hormonal therapy (CHT) can be considered safe in transwomen improving the well-being and quality of life of these individuals. Long-term monitoring should aim to decrease cardiovascular risks and should include prostate and breast cancer screenings.

Scalp Hair Regrowth in Hormone-Treated Transgender Woman

“…7,8 In one small study examining the effect of spironolactone on genital skin 5α-reductase activity in vivo of hirsute women, spironolactone was found to have a direct inhibitory effect of 5α-reductase, thereby decreasing conversion of testosterone to DHT. 9 Spironolactone is not commonly used to treat male pattern baldness, however, given the side effects of gynecomastia, impotence, and feminization of hair patterns.…”

Cyproterone acetate vs leuprolide acetate in combination with transdermal oestradiol in transwomen: a comparison of safety and effectiveness

“…The mainstay of cross‐sex hormonal therapy (CHT) in transwomen is the suppression of endogenous testosterone production and oestrogen replacement to suppress male phenotypic characteristics and to develop female characteristics. For this purpose, different agents such as cyproterone acetate (CPA), spironolactone or GnRH analogues are most commonly used in combination with different oestrogen molecules given through varied routes of administration …”

“…For this purpose, different agents such as cyproterone acetate (CPA), spironolactone or GnRH analogues are most commonly used in combination with different oestrogen molecules given through varied routes of administration. 1,2 CPA is widely used outside the US where it is not available for various gynaecological, urological and endocrinological conditions. CPA is a progestogen with potent anti-androgenic activities acting through profound suppression of gonadotrophins and testicular androgen secretion, and through competition with androgens for the androgen receptor.…”

Andrology of male‐to‐female transsexuals: influence of cross‐sex hormone therapy on testicular function

“…Furthermore, estrogen treatment should be continued after SRS to prevent hypogonadism (Meriggiola et al . ). In order to achieve a better standardization of treatment results, including the effect on spermatogenesis, a higher standardization of treatment protocols appears to be essential.…”

“…clotting disorders, osteoporosis, obesity, osteoporosis, hypertension, breast cancer), which rule out estrogen treatment of any kind. Venous thromboembolism is the most serious complication and incidents have been reported for both transdermal and oral estradiol (Meriggiola & Gava, ). If taken accordingly, the anti‐androgens reduce endogenous testosterone levels.…”