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

Abstract

Summary Gender dysphoria (GD) is characterized by discomfort with the assigned or birth gender and the urge to live as a member of the desired sex. The goal of medical and surgical treatment is to improve the well‐being and quality of life of transpeople. The acquisition of phenotypic features of the desired gender requires the use of cross‐sex hormonal therapy (CHT). Adult transmen are treated with testosterone to induce virilization. In adolescents with severe and persistent GD, consideration can be given to arresting puberty at Tanner Stage II and if dysphoria persists, CHT is generally started after 16 years of age. Currently available short‐ and long‐term safety studies suggest that CHT is reasonably safe in transmen. Monitoring of transmen should be more frequent during the first year of cross‐sex hormone administration reducing to once or twice per year thereafter. Long‐term monitoring after sex reassignment surgery (SRS) includes annual check‐ups as are carried out for natal hypogonadal men. In elderly transmen, special attention should be paid to haematocrit in particular. Screening for breast and cervical cancer should be continued in transmen not undergoing SRS.

Provision of Patient‐Centered Transgender Care

“…Some individuals prefer a testosterone transdermal system (Androderm) for convenience and comfort reasons. Testosterone therapy should not be given to pregnant individuals or those with severe cardiovascular disease …”

“…Testosterone use, obesity, hypertension, and a sedentary lifestyle combined with smoking, which are speculated to be more prevalent in trans men than the general population, further increases the risk for a thromboembolic or cardiovascular event . Elevated rates of obesity increase the risk for type 2 diabetes.…”

“…Elevated rates of obesity increase the risk for type 2 diabetes. Periodic annual screening for elevated blood pressure, polycythemia, fasting glucose or glycated hemoglobin (A 1C ) level, and fasting lipids are recommended to identify early development of cardiovascular disease and diabetes . Screening for bone demineralization will detect osteoporosis.…”

“…Progesterone may be used in trans men to suppress menstruation for a short time, especially if transdermal testosterone is used rather than parenteral dosing, but it is rarely used on an ongoing basis . If the uterus remains intact and contraception is desired, a progestin‐secreting intrauterine device may be used.…”

“…Guidelines for mammography screening for those who have breast tissue intact or have undergone mastectomy should be the same as for cisgender populations until further research is completed . However, more research, in the form of randomized controlled trials to determine the exact effects of long‐term cross hormone use on breast tissue, is needed to create specific guidelines for breast cancer screening in the transgender population …”