Oestrogen and anti-androgen therapy for transgender women

Abstract

Transgender women experience lifelong gender dysphoria due to a gender assignment at birth that is incongruent with their gender identity. They often seek hormone therapy, with or without surgery, to improve their gender dysphoria and to better align their physical and psychological features with a more feminine gender role. Some of the desired physical changes from oestrogen and anti-androgen therapy include decreased body and facial hair, decreased muscle mass, breast growth, and redistribution of fat. Overall the risks of treatment are low, but include thromboembolism, the risk of which depends on the dose and route of oestrogen administration. Other associated conditions commonly seen in transgender women include increased risks of depression and osteoporosis. The risk of hormone-sensitive cancer seems to be low in transgender women, with no increased risk of breast cancer compared with women and no increase in prostate cancer when compared with men. The evidence base for the care of transgender women is limited by the paucity of high-quality research, and long-term longitudinal studies are needed to inform future guidelines.

Gender and Sex Differences in Adipose Tissue

“…In the transgender population, cross-sex hormone therapy is commonly used in the transition process [111•]. For feminization, estrogen is given in combination with antiandrogen drugs to decrease testosterone and minimize masculine physical characteristics [112].…”

The Perioperative Care of the Transgender Patient

“…Rates of VTE in the literature for transgender women on estrogen therapy range from 0% to 6%. 47,48 Protocols on the use of estrogen in transgender women should consider additional VTE risk factors such as smoking, hypercoagulable disorders, cancer diagnosis, length of surgery, and duration of immobilization. 47 Because of this, intraoperative VTE prophylaxis in the form of subcutaneous heparin and sequential compression devices are essential.…”

Long term hormonal treatment for transgender people

“…To achieve full suppression in all people, most guidelines recommend the use of oestrogen in combination with a testosterone suppressing agent 37. Testosterone suppressing agents (or anti-androgens) of several pharmacological classes are available (table 1).…”

“…Important effects of combined oestrogen and anti-testosterone treatment include breast development, softer skin, loss of sexual hair growth, increase in fat mass, broader hips, a decrease of lean body mass, and a decrease or change in libido with clinically relevant mood changes 7. Not all effects are as strong in every person.…”

“…With growing numbers of transgender people presenting to healthcare services (estimated as 9.2 per 100 0001), general practitioners, general endocrinologists, and other doctors will become increasingly involved in their long term care, the prescription of hormones, and consideration of potential side effects. Several guidelines are available on the start of hormonal treatment234567; the focus of this article is the long term hormonal care for transgender people who might no longer attend a specialist clinic. It is aimed at a more general readership of physicians occasionally seeing adult transgender people.…”