Prescribing for transgender patients

Abstract

With greater awareness and social acceptance, increasing numbers of transgender individuals are presenting for gender-affirming hormone treatment. There should be a full psychosocial assessment by an experienced clinician before hormone treatment is considered.People assigned as males at birth who transition to female gender are transgender females. Their management includes an estrogen plus an anti-androgen.People assigned as females at birth who transition to male gender are transgender males. Their hormone treatment is testosterone.Treatment is titrated so that hormone concentrations are equivalent to the physiological concentrations of the preferred gender. This aims to minimise adverse effects.Many decades of experience with gender-affirming hormone treatment have been accumulated and several guidelines published. [2][3][4][5] Although prescribing remains off label, treatments are relatively straightforward and safe, resembling those used for postmenopausal women or hypogonadal men.

Population pharmacokinetics of tenofovir, emtricitabine and intracellular metabolites in transgender women

“…However, there are barriers to PrEP uptake, including access to care, social stigma and patient concerns regarding the impact of PrEP on gender-affirming hormonal therapies (GAHT). [2][3][4] TGW frequently access oestrogen-based GAHT to induce physical changes and promote congruence with their gender identity; these therapies may also include anti-androgenic agents. 5,6 The World Professional Association for Transgender Health has published transgender-focused recommendations to promote feminization and reduce gender dysphoria in TGW.…”

A Link Between Migraine and Prolactin: the Way Forward

“…When it comes to hormones and pain, transgender and transsexual individuals must not be neglected. These individuals undergo the transition period, which includes hormone therapy, surgery or both [ 40 ]. Set aside the prolactin and other hormones, very limited information is available related to sex hormone therapy and alterations in pain perception.…”

IDEA group consensus statement on medical management of adult gender incongruent individuals seeking gender reaffirmation as female

“…Consensus: The expert group recommends the use of available estrogen preparations, keeping in mind the doses, advantages and limitations of each preparation [ Annexure 5: Table 2 ]. [ 26 27 28 ]…”

“… GnRH agonists[ 28 32 ]: Triptorelin depot 3.75 mg monthly or 11.25 mg 3 monthly (IM or SC)/Leuprolide3.75 mg monthly or 11.25 mg 3 monthly (IM or SC)/Goserelin3.6 mg monthly or 10.8 mg every 3 monthly (SC upper abdominal wall) Action – decrease the release of gonadotropins and thereby production of sex hormones by the gonads Adverse effect - decreased libido, headache and decreased bone mineral density Limitation - Expensive and need to be injected. Spironolactone: Dose - 100-400 mg per day[ 27 30 ] Action - a diuretic used as an antihypertensive agent and directly inhibits testosterone secretion and androgen binding to the androgen receptor Adverse effect - fall in blood pressure and electrolyte imbalance. 5-alpha reductase inhibitors (finasteride 5 mg per day or dutasteride 0.5 mg per day)[ 28 31 ]: Action - block the conversion of testosterone to 5-alpha dihydrotestosterone and is used when there is residual testosterone Effect - reduce scalp hair loss, body hair growth, sebaceous glands secretion Adverse effect - Erectile dysfunction (not an issue in transfaminine individual).…”

“… Dose - 100-400 mg per day[ 27 30 ] Action - a diuretic used as an antihypertensive agent and directly inhibits testosterone secretion and androgen binding to the androgen receptor Adverse effect - fall in blood pressure and electrolyte imbalance. …”