Gender-affirming hormone therapy: Difference between revisions

Eligibility for transgender hormone therapyGAHT may require an assessment for [[gender dysphoria]] or persistent gender incongruence; or many medical institutions now use an [[informed consent]] model, which ensures patients are informed of the procedure process, including possible benefits and risks, while removing many of the historical barriers needed to start hormone therapy. Treatment guidelines for therapy have been developed by several medical associations.

Many international guidelines and institutions require persistent, well-documented gender dysphoria as a pre-requisite to starting gender-affirmation therapy. [[Gender dysphoria]] refers to the psychological discomfort or distress that an individual can experience if their sex assigned at birth is incongruent with that person's gender identity.<ref name="ColemanBockting2012">{{cite journal | vauthors = Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfaefflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, K Zucker K |display-authors=6 |title= Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 |journal=International Journal of Transgenderism |date=August 2012 |volume=13 |issue=4 |pages=165–232 |doi=10.1080/15532739.2011.700873|s2cid=39664779}}</ref> Signs of gender dysphoria can include comorbid mental health stressors such as [[depression (mood)|depression]], anxiety, low [[self-esteem]], and [[social isolation]].<ref>{{Cite web|date=2017-10-23|title=Gender dysphoria|url=https://www.nhs.uk/conditions/gender-dysphoria/|access-date=2021-11-15|website=nhs.uk|language=en|archive-date=2020-03-20|archive-url=https://web.archive.org/web/20200320050603/https://www.nhs.uk/conditions/gender-dysphoria/|url-status=live}}</ref> Not all [[gender nonconforming]] individuals experience gender dysphoria, and measuring a person's gender dysphoria is critical to when considering medical intervention for gender nonconformity.<ref>{{cite journal | vauthors = Olson-Kennedy J, Cohen-Kettenis PT, Kreukels BP, Meyer-Bahlburg HF, Garofalo R, Meyer W, Rosenthal SM | title = Research priorities for gender nonconforming/transgender youth: gender identity development and biopsychosocial outcomes | journal = Current Opinion in Endocrinology, Diabetes, and Obesity | volume = 23 | issue = 2 | pages = 172–179 | date = April 2016 | pmid = 26825472 | pmc = 4807860 | doi = 10.1097/MED.0000000000000236 }}</ref>

For transgender youth, the [[Dutch protocol]] existed as among the earlier guidelines for hormone therapy by delaying puberty until age 16.<ref>{{Cite journal |last1=Shumer |first1=Daniel E. |last2=Spack |first2=Norman P. |date=January 2015 |title=Paediatrics: Transgender medicine--long-term outcomes from 'the Dutch model' |journal=Nature Reviews. Urology |volume=12 |issue=1 |pages=12–13 |doi=10.1038/nrurol.2014.316 |issn=1759-4820 |pmc=4349440 |pmid=25403246}}</ref><ref>{{Cite journal |last1=Delemarre-van de Waal |first1=Henriette A |last2=Cohen-Kettenis |first2=Peggy T |date=November 2006 |title=Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects |url=https://doi.org/10.1530/eje.1.02231 |journal=European Journal of Endocrinology |volume=155 |issue=suppl_1 |pages=S131–S137 |doi=10.1530/eje.1.02231 |issn=0804-4643 |access-date=2024-02-17 |archive-date=2024-03-11 |archive-url=https://web.archive.org/web/20240311212505/https://academic.oup.com/ejendo/article-abstract/155/Supplement_1/S131/6695708?redirectedFrom=fulltext |url-status=live }}</ref> The [[World Professional Association for Transgender Health]] (WPATH) and the [[Endocrine Society]] later formulated guidelines that created a foundation for health care providers to care for transgender patients.<ref>{{Cite journal |last1=Hembree |first1=Wylie C. |last2=Cohen-Kettenis |first2=Peggy |last3=Delemarre-van de Waal |first3=Henriette A. |last4=Gooren |first4=Louis J. |last5=Meyer |first5=Walter J. |last6=Spack |first6=Norman P. |last7=Tangpricha |first7=Vin |last8=Montori |first8=Victor M. |date=2009-09-01 |title=Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline |url=https://doi.org/10.1210/jc.2009-0345 |journal=The Journal of Clinical Endocrinology & Metabolism |volume=94 |issue=9 |pages=3132–3154 |doi=10.1210/jc.2009-0345 |pmid=19509099 |issn=0021-972X |doi-access=free |access-date=2024-02-17 |archive-date=2024-07-25 |archive-url=https://web.archive.org/web/20240725032504/https://academic.oup.com/jcem/article/94/9/3132/2596324 |url-status=live }}</ref><ref>{{cite journal | vauthors = Unger CA | title = Hormone therapy for transgender patients | journal = Translational Andrology and Urology | volume = 5 | issue = 6 | pages = 877–884 | date = December 2016 | pmid = 28078219 | pmc = 5182227 | doi = 10.21037/tau.2016.09.04 | doi-access = free }}</ref> [[University of California, San Francisco|UCSF]] guidelines are also sometimes used.<ref name="UCSF_Transgender_Care" /> There is no generally agreed-upon set of guidelines, however.<ref>{{Cite journal |last1=Houssayni |first1=Sarah |last2=Nilsen |first2=Kari |date=Feb 28, 2018 |title=Transgender Competent Provider: Identifying Transgender Health Needs, Health Disparities, and Health Coverage |journal=Kansas Journal of Medicine |volume=11 |issue=1 |pages=15–19 |doi=10.17161/kjm.v11i1.8679 |pmid=29844850 |pmc=5834239 }}</ref>

'''Sources:''' ''Guidelines:''<ref name="pmid28945902">{{cite journal | vauthors = Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG | display-authors = 6 | title = Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 102 | issue = 11 | pages = 3869–3903 | date = November 2017 | pmid = 28945902 | doi = 10.1210/jc.2017-01658 | s2cid = 3726467 | doi-access = free }}</ref><ref name="ColemanBockting2012" /><ref name="Bourns2018">{{cite web | vauthors = Bourns A | title = Guidelines and Protocols for Comprehensive Primary Care for Trans Clients | publisher = Sherbourne Health Centre | year = 2015 | access-date = 15 August 2018 | url = http://sherbourne.on.ca/wp-content/uploads/2014/02/Guidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2015.pdf | archive-date = 10 May 2020 | archive-url = https://web.archive.org/web/20200510012134/http://sherbourne.on.ca/wp-content/uploads/2014/02/Guidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2015.pdf | url-status = live }}</ref> ''Reviews/book chapters:'' <ref name="pmid25403429c">{{cite journal | vauthors = Fabris B, Bernardi S, Trombetta C | title = Cross-sex hormone therapy for gender dysphoria | journal = Journal of Endocrinological Investigation | volume = 38 | issue = 3 | pages = 269–282 | date = March 2015 | pmid = 25403429 | doi = 10.1007/s40618-014-0186-2 | hdl-access = free | s2cid = 207503049 | hdl = 11368/2831597 }}</ref><ref name="pmid12915619a">{{cite journal | vauthors = Moore E, Wisniewski A, Dobs A | title = Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 88 | issue = 8 | pages = 3467–3473 | date = August 2003 | pmid = 12915619 | doi = 10.1210/jc.2002-021967 | doi-access = free }}</ref><ref name="AsschemanGooren1993">{{cite journal | vauthors = Asscheman H, Gooren LJ | title = Hormone Treatment in Transsexuals | journal = Journal of Psychology & Human Sexuality | volume = 5 | issue = 4 | year = 1993 | pages = 39–54 | issn = 0890-7064 | doi = 10.1300/J056v05n04_03| s2cid = 144580633 }}</ref><ref name="pmid14510900u">{{cite journal | vauthors = Levy A, Crown A, Reid R | title = Endocrine intervention for transsexuals | journal = Clinical Endocrinology | volume = 59 | issue = 4 | pages = 409–418 | date = October 2003 | pmid = 14510900 | doi = 10.1046/j.1365-2265.2003.01821.x | s2cid = 24493388 }}</ref> ''Studies:''<ref name="deKlaver2016">{{cite journal | vauthors = de Blok C, Klaver M, Nota N, Dekker M, den Heijer M | title = Breast development in male-to-female transgender patients after one year cross-sex hormonal treatment | journal = Endocrine Abstracts | year = 2016 | volume = 41 | issn = 1479-6848 | doi = 10.1530/endoabs.41.GP146}}</ref><ref name="pmid29165635">{{cite journal | vauthors = de Blok CJ, Klaver M, Wiepjes CM, Nota NM, Heijboer AC, Fisher AD, Schreiner T, T'Sjoen G, den Heijer M | display-authors = 6 | title = Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 103 | issue = 2 | pages = 532–538 | date = February 2018 | pmid = 29165635 | doi = 10.1210/jc.2017-01927 | s2cid = 3716975 | doi-access = free }}</ref>}}

[[Masculinizing hormone therapy]] is typically used by transgender men, who desire the development of masculine secondary sex characteristics. Masculinizing hormone therapy usually includes [[testosterone (medication)|testosterone]] to produce [[masculinization]] and suppress the production of [[estrogen]].<ref>{{Cite web|url=https://www.mayoclinic.org/tests-procedures/ftm-hormone-therapy/about/pac-20385099|title=Masculinizing hormone therapy - Mayo Clinic|website=www.mayoclinic.org|access-date=2019-08-02|archive-date=2019-07-16|archive-url=https://web.archive.org/web/20190716035520/https://www.mayoclinic.org/tests-procedures/ftm-hormone-therapy/about/pac-20385099|url-status=live}}</ref> Treatment options include [[oral administration|oral]], [[parenteralSubcutaneous administration|subcutaneous injections]], or [[subcutaneous implant|implant]], and [[transdermal administration|transdermal]] ([[transdermal patch|patches]], [[transdermal gel|gel]]s). Dosing is patient-specific, depending on the patient's rate of [[metabolism]], and is discussed with the physician.<ref name="Transgender_Care_Testosterone">{{Cite web|url=https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy|title=Information on Testosterone Hormone Therapy|work=Transgender Care|publisher=transcare.ucsf.edu|access-date=2019-08-07|archive-date=2019-11-22|archive-url=https://web.archive.org/web/20191122161637/https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy|url-status=live}}</ref> The most commonly prescribed methods are [[intramuscular injection|intramuscular]] and [[subcutaneous injection]]s.{{Citation needed|date=August 2024}} This dosing can be daily, weekly or biweekly depending on the [[route of administration]] and the individual patient.{{Citation<ref needed|datename=October"Transgender_Care_Testosterone" 2019}}/>

The desired effects of masculinizing hormone therapy focus on the development of masculine [[secondary sex characteristic]]s. These desired effects include: increased muscle mass, increased bone turnover,<ref>{{Cite journal |last1=Van Caenegem |first1=E |last2=Wierckx |first2=K |last3=Taes |first3=Y |last4=Schreiner |first4=T |last5=Vandewalle |first5=S |last6=Toye |first6=K |last7=Lapauw |first7=B |last8=Kaufman |first8=J-M |last9=T'Sjoen |first9=G |date=February 2015 |title=Body composition, bone turnover, and bone mass in trans men during testosterone treatment: 1-year follow-up data from a prospective case–controlled study (ENIGI) |url=https://academic.oup.com/ejendo/article-abstract/172/2/163/6660907?redirectedFrom=fulltext |journal=European Journal of Endocrinology |volume=172 |issue=2 |pages=163–171 |doi=10.1530/eje-14-0586 |pmid=25550352 |issn=0804-4643}}</ref> development of facial hair, voice deepening, increase and thickening of body hair, and more.<ref>{{Cite web | vauthors = Deutsch MB | date = 17 June 2016 | title = Overview of masculinizing hormone therapy | work = UCSF Gender Affirming Health Program | url = https://transcare.ucsf.edu/guidelines/masculinizing-therapy | access-date = 2021-11-12 | location = San Francisco, CA | publisher = The University of California | archive-date = 2023-06-19 | archive-url = https://web.archive.org/web/20230619070340/https://transcare.ucsf.edu/guidelines/masculinizing-therapy | url-status = live }}</ref>

|Increased RBCred blood cell count

Hormone therapy for transgender individuals has been shown in medical literature to be generally safe, when supervised by a qualified medical professional.<ref>{{cite journal | vauthors = Weinand JD, Safer JD | title = Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals | journal = Journal of Clinical & Translational Endocrinology | volume = 2 | issue = 2 | pages = 55–60 | date = June 2015 | pmid = 28090436 | pmc = 5226129 | doi = 10.1016/j.jcte.2015.02.003 }}</ref> There are potential risks with hormone treatment that will be monitored through screenings and lab tests such as blood count (hemoglobin), kidney and liver function, blood sugar, potassium, and cholesterol.<ref name="Transgender_Care_Testosterone" /><ref name="Transgender_Care_Estrogen" /> Taking more medication than directed may lead to health problems such as increased risk of cancer, heart attack from thickening of the blood, blood clots, and elevated cholesterol.<ref name="Transgender_Care_Testosterone" /><ref>{{cite journal | vauthors = | title = A randomized, double-blind study of two combined oral contraceptives containing the same progestogen, but different estrogens. World Health Organization Task Force on Oral Contraception | journal = Contraception | volume = 21 | issue = 5 | pages = 445–459 | date = May 1980 | pmid = 7428356 | doi = 10.1016/0010-7824(80)90010-4 }}</ref>Hormone therapy has been shown to improve the psychosocial well-being among transgender individuals. It's been seen to lower levels of distress in transgender individuals. <ref>{{Cite journal |last1=Doyle |first1=David Matthew |last2=Lewis |first2=Tom O. G. |last3=Barreto |first3=Manuela |date=August 2023 |title=A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people |journal=Nature Human Behaviour |language=en |volume=7 |issue=8 |pages=1320–1331 |doi=10.1038/s41562-023-01605-w |pmid=37217739 |issn=2397-3374|pmc=10444622 }}</ref>

Transgender hormone therapyGAHT may limit fertility potential.<ref name="T'Sjoen_2013">{{cite journal | vauthors = T'Sjoen G, Van Caenegem E, Wierckx K | title = Transgenderism and reproduction | journal = Current Opinion in Endocrinology, Diabetes, and Obesity | volume = 20 | issue = 6 | pages = 575–579 | date = December 2013 | pmid = 24468761 | doi = 10.1097/01.med.0000436184.42554.b7 | s2cid = 205398449 }}</ref> Should a transgender individual choose to undergo [[gender-affirming surgery]], their fertility potential is lost completely.<ref name="De_Sutter_2001">{{cite journal | vauthors = De Sutter P | title = Gender reassignment and assisted reproduction: present and future reproductive options for transsexual people | journal = Human Reproduction | volume = 16 | issue = 4 | pages = 612–614 | date = April 2001 | pmid = 11278204 | doi = 10.1093/humrep/16.4.612 }}</ref> Before starting any treatment, individuals may consider fertility issues and [[fertility preservation]]. Options include [[semen cryopreservation]], [[oocyte cryopreservation]], and [[ovarian tissue cryopreservation]].<ref name="T'Sjoen_2013" /><ref name="De_Sutter_2001" />

===FakeCounterfeit products===

Some organizations – butorganizations—but fewer than in the past – requirepast—require that patients spend a certain period of time living in their desired gender role before starting hormone therapy. This period is sometimes called real-life experience (RLE).

In Sweden, for instance, patients seeking to access gender affirming healthcare must first undergo extended evaluations with psychiatric professionals, during which they must - withoutmust—without any form of medical transition - successfullytransition—successfully live for one full year as their desired gender in all professional, social, and personal matters. Gender clinics are recommended to provide patients with wigs and breast prostheses for the endeavor. The evaluation additionally involves, if possible, meetings with family members and/or other individuals close to the patient. Patients may be denied care for any number of "psychosocial dimensions", including their choice of job or their marital status.<ref>{{Cite journal |journal=Sexuality Research and Social Policy |title=Two Steps Forward, One Step Back: A Policy Analysis of the Swedish Guidelines for Trans-Specific Healthcare |last1=Linander |first1=Ida |last2=Lauri |first2=Marcus |year=2021 |volume=18 |issue=2 |pages=309–320 |doi=10.1007/s13178-020-00459-5|s2cid=256073192 |doi-access=free }}</ref><ref>{{Cite web |url=https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/konsdysfori-vuxna-metodbilaga.pdf |title=God vård av vuxna med könsdysfori |access-date=2024-02-07 |archive-date=2024-07-25 |archive-url=https://web.archive.org/web/20240725032349/https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/konsdysfori-vuxna-metodbilaga.pdf |url-status=live }}</ref>

[[Category:Gender transitioningtransition and medicine]]