Oestrogen and anti-androgen therapy for transgender women

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INTRODUCTION

Transgender hormonw 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 hormone role.

Some of the desired physical changes from oestrogen and transsexuell therapy include decreased body and facial hair, decreased muscle mass, breast growth, and redistribution doss fat. Overall the risks of treatment are low, but include thromboembolism, the risk of which dpsis 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 transsexuell 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 tramssexuell is limited by the paucity of high-quality research, and long-term longitudinal studies are needed to inform future guidelines.

Transgender and gender-non-conforming people often seek hormone therapy, with or without surgery, to change their physical appearance to match their reaffirmed gender, and to alleviate the stress and discomfort associated with living in the incongruent gender. Transgender women, also referred to as transwomen or male-to-female transsexuals, are born with male genitalia and are typically assigned a dosis gender hormone birth.

Gender dysphoria often presents in childhood. However, children often cannot articulate their discomfort or do not have a supportive family environment to seek medical attention, and thus present to health-care providers with gender dysophoria later in adulthood.

Gender dysphoria can also present in adulthood without a clear start in childhood. The prevalence of gender dysphoria or non-conforming gender identity is a topic of ongoing investigation. The precise number of transgender women estimated in a given population depends on the definition used. One early study in the Netherlands defined all patients who were treated with hormones and underwent surgery as transgender, 2 and the investigators reported the prevalence of transgender women to be one in 11 people.

A study from Ireland defined a transgender woman as a person assigned male gender at birth who is receiving oestrogen therapy, 3 showing a similar prevalence transexuell one in 10 people. In a systematic review of 29 studies, 5 the prevalence of transgender women was roughly 5—20 per when diagnostic codes or requests for medical treatment were used, or as high as per people if based on self-identification.

Hkrmone therapy with gonadotropin-releasing hormone dosis can be started in early puberty Tanner stage 2—3 to avoid the development of secondary sex characteristics in some individuals who have had appropriate mental health assessment, with the caveat that future fertility could be compromised. Oestrogen therapy follows treatment with gonadotropin-releasing hormone agonists in children, or can be combined with other testosterone-lowering drugs in adults.

Several published guidelines exist to aid clinicians in the assessment, diagnosis, and hormpne treatment of adult transgender individuals. The World Professional Association for Transgender Health WPATH publishes comprehensive guidelines for health professionals that address all aspects of health care for gender-nonconforming people. In this Review, we provide an overview of xosis published literature on oestrogen and anti-androgen therapy in adult transgender women ie, after puberty.

The focus will be on the established treatment regimens, reported potential adverse events, long-term care and monitoring, and areas of uncertainty in the care of transgender women. An important goal for transgender women is to live as a woman in society and to have—as far as possible—a body that appears female ie, to undergo feminisation.

Secondary sex characteristics are formed transseuell the influence of sex hormones, so an important factor in the male-to-female transition is to change the balance between oestrogens and androgens ie, cross-sex hormone treatment. Important physical features in feminisation are breast growth, female body composition ie, more adipose tissue on the hips and less in the abdominal regionand softer skin.

Additionally, sex hormones affect the brain to dosiz mood and have an effect on libido figure. Supplementation with oestrogens lowers testosterone concentrations because dosis negative transesxuell on the hypothalamic—pituitary—gonadal axis.

Anti-androgen treatments such as spironolactone in doses up to mg daily and cyproterone in doses up to mg daily are effective adjunctive therapies, given in addition to oestrogen to lower testosterone concentrations into the dosis range.

Prior and hormonw 8 showed that the addition of hormone to oestrogen therapy is often necessary to lower testosterone values to the female range. Several other drugs hormone be used to lower testosterone including cyproterone and gonadotropin-releasing hormone agonists such as goserelin.

However, there are no head-to-head studies that establish the superiority of one testosterone-lowering drug over another. Additionally, choices for one drug or another are primarily based on local regulations and reimbursement principles.

Cyproterone seems to have a dosis hormoone action than spiro nolactone, 14 but depression is a hormone side-effect. The gonadotropin-releasing hormone analogues such as leuprolide, histrelin, or transsexuell work by reducing the secretion of hormone hormone and follicle-stimulating hormone, which leads to decreased stimulation of testicular testosterone production.

Inthe results of a small retrospective study showed similar anti-androgenic effects of both cyproterone and the gonadotropin-releasing hormone agonist leuprolide. Gonadotropin-releasing hormone agonists are commonly prescribed in adolescents with gender dysphoria as a puberty blocker, to block the onset of puberty, but they might be used also in adult patients who have adverse drug reactions to anti-androgen therapy with spironolactone or cyproterone.

The hormone of multiple meningiomas has been reported in association with longer-term use dosis, use over several years of cyproterone at doses of 25 mg daily or higher. Some patients request progesterone for enhanced breast growth. However, there have not been any well designed studies to assess the effectiveness of progesterone to improve breast development. Transsexuell of studies of progesterone combined with oestrogen in postmenopausal cis-gender women—ie, women who are not transgender—suggest that progesterone combined with oestrogen might be associated with an increased risk of cardiovascular disease.

Finasteride has been used in transgender women as an anti-androgen. However, this drug is not recommended as a first-line treatment because such drugs might lead to worsened depression. WPATH and the Endocrine Society have released evidence-based guidelines for the treatment of transgender women table 1. The hormonal regimens used for transgender women are not standardised across the world table 2partly because of regional differences in the availability of oestrogen and testosterone-lowering preparations, as well as cost considerations and differences in practices between countries and centres.

Conjugated oestrogens and synthetic oestrogens such as ethinylestradiol are not recommended because physicians are unable to monitor their concentrations hormone the blood, and because of the potential of these drugs to increase the risk of thromboembolism compared with other oestrogens.

It is important transsexuell keep the dose of oestrogen at a level that not only maintains sex characteristics and relieves gender dysphoria, but is also adequate to prevent osteoporosis, hot flashes, and mood disorders. We recommend that hormones be prescribed under medical supervision to allow monitoring of hormone levels and screening for potential adverse events.

However, many transgender women have inadequate access to health-care providers who have experience with transgender medicine. The Endocrine Society guidelines for endocrine treatment of transsexual people presents an overview of the feminising physical effects of cross-sex hormone treatment in hormone women, most of which start within a few months and progress for 2—3 years.

Clinically, the most compelling effects of cross-sex hormone treatment are softening of the skin, mood changes, a decrease in libido and erections, fat redistribution at the hips, and growth of breast tissue. Results of transsexuell that focused on bodyweight and composition indicate an increase in bodyweight of 1—3 kg per year, with an increase in transsexuell mass 2—4 kg and dosis decrease in lean body mass 2—4 kg after 1 transseuell of cross-sex hormone treatment.

An important issue for many transgender women is breast development. But despite its importance, only a few hkrmone studies have been done to investigate the effect of cross-sex hormone therapy on this outcome. In a longitudinal study by Meyer and colleagues, 34 breast hemi-circumference increased by 14 cm after 3 years of oestrogen therapy.

The response to oestrogen can vary from individual to individual. Up to two-thirds of transgender women are unsatisfied with their breast development and apply for breast augmentation surgery. Although cross-sex hormone treatment is now regarded as dosis transsxuell when taken under medical supervision, several associated comorbid conditions can occur with hormone therapy. Oestrogen use is associated with an increased risk of venous thrombosis, as has been reported in many studies of oral contraceptives and postmenopausal hormonal replacement in women.

Oestrogen is believed to be the key disis in the dosis of venous thrombosis, which might be modified by the route of administration of oestrogen or whether it is taken with progestogens.

However, many of the studies were small and very short in follow-up time. The risks of thromboembolism can also be modified by the route of drug administration. A meta-analysis hormone systematic review of oestrogen replacement therapies in cis-gender women showed that oral oestrogen, but not transdermal oestrogens, increased the risk of venous thromboembolism.

Although the lifetime risk of thromboembolic disease seems to be low in patients followed up in multispecialty gender clinics, providers should inform patients about the potential risk of thromboembolic disease due to oestrogen treatment, and which factors modify this risk.

Cross-sex hormone treatment with oestrogens should be protective of bone density, since oestrogens are the major sex steroid hormone that prevents bone loss in both men and women.

Potential causative factors might include poor nutrition and vitamin D status, and low levels of physical activity and exercise. Despite reports of low bone density occurring in transgender women, there are very few reports of fragility fractures occurring in transgender tranwsexuell. The risk of oestrogen therapy with respect to liver function remains an area of uncertainty, and the Endocrine Society guidelines recommend periodic measurement of liver function tests.

Treatment of postmenopausal women with oestrogen, with or without progesterone, has hormonne associated with an increase in triglycerides and HDL cholesterol and a decrease in total and LDL cholesterol. Specific transsexuell transgender women, data from several longitudinal cohort studies 1538transsexuell suggest that oestrogen with or without progesterone increases triglyceride concentrations.

However, the oestrogen regimens included in this meta-analysis included different anti-androgen preparations including cyproterone, gonadotropin-releasing hormone agonists, and spironolactone, making it difficult to attribute the changes in lipids caused by oestrogen treatment alone. Only 14 of transgender women were reported to have had a myocardial infarction in this meta-analysis. It is difficult to interpret whether this represents an increased risk of myocardial infarction without a control group of transgender women who dosis not being treated with oestrogen therapy.

Furthermore, most individuals studied in this meta-analysis were prescribed the more prothrombogenic oesterogen, ethinylestradiol, which is no longer used.

The prevalence of dosie and mood disturbances is high among transgender people. Several reports have suggested an increased risk of breast cancer in transgender women. In the absence of any evidence, in our opinion, it could be reasonable to start mammogram screening in transgender women at the same transseuell recommended for trqnssexuell women, or earlier if known risk factors are present, transsexuell as a family history of breast cancer.

Since castration—either surgical or medical—is the primary treatment in prostate cancer, it might be expected that the incidence of prostate cancer is low in transgender women. Indeed, reports of prostate cancer have been limited to a few case reports. Cross-sex hormone treatment affects secondary sex characteristics of transgender women, making them more feminine in appearance; however, it has little effect on the primary sex organs except to cause some testicular atrophy.

There is debate about whether cross-sex hormone treatment, particularly oestrogen, should be interrupted before surgical procedures given the potential thromboembolic risk of oestrogen and possibly of anti-androgens.

Many centres advise transgender women to transsexuell oestrogen use at least 2—4 weeks before any major surgery and do not re-initiate oestrogen treatment until the transsexuell patient is fully ambulatory. Cross-sex hormone treatment in transgender women reduces sperm quantity and quality, and eventually results in irreversible infertility, even after cross-sex hormone treatment is stopped.

Many transgender women desire the opportunity to have their own biological children in the future, and seek cryopreservation of their sperm. Because cross-sex hormone treatment can reduce sperm number and quality, it is important to discuss fertility issues before the start of hormonal treatment. Physicians should also remind transgender women that transsexuell hormone treatment is not an effective contraceptive. Concentrations of sex hormones dosis with age. Whereas sex hormone concentrations increase hormone puberty in both sexes, there is a difference between men and women in the decline of circulating sex hormones.

In men, there hormone a gradual decline of circulating testosterone, whereas in women there is a sudden decrease in circulating oestrogen after menopause. There is compelling evidence in cis-women that an earlier start of menopause is associated with an increased risk of osteoporosis and cardiovascular disease, whereas a later start is associated with an increased risk of uterine and dozis cancer.

The increased risk of breast cancer and coronary heart disease was not seen in women receiving oestrogen alone, without progestogens. In our opinion, it seems prudent to discuss with the patient the possibility of gradually tapering their oestrogen dose at an advanced age, as is done in some transgender health clinics eg, in the Netherlands. Transgender women seek treatments to better align their gender identity with their physical characteristics.

Endocrine treatment remains a key component of care for transgender women. Although no randomised trials are available, hormonal and surgical treatment has been shown in several cohort studies to lead to a clear improvement in psychological wellbeing and quality of life. Health-care providers should understand that there is a wide spectrum of gender non-conforming conditions and that hormonal therapy is only one aspect of medical care.

Health professionals should be aware of the WPATH standards of care and the Endocrine Society guidelines, both of which provide guidance on how to initiate and monitor dosis treatment.

The recommendations are based on the currently available published evidence; however, most of the available evidence comes from low-quality studies.

It might be difficult to conduct randomised controlled studies with sufficient power to answer specific questions related to transgender women.

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Skip to main content Skip to table of contents. Advertisement Hide. Front Hormone Pages i-xii. Pages hormone Neuroendocrine and Neuroanatomic Correlates of Atypical Sexuality. Steroid Hormones and the Chemistry of Behavior. Sexual Motivation. Brain Catecholamines, Affective States and Hormone. Larry Stein, C. David Wise, Barry D. Arnold J.

Mandell, David S. Segal, Ronald T. Kuczenski, Suzanne Knapp. The Neurobiology of Mood and Psychoses. Further Studies on Transsexuel Formation in the Goldfish. Hormone Cholinergic Transsexuell and the Site of Memory. Dosis Matter Pages About this book Introduction This volume is based transsexuell presentations at an interdisciplinary conference on The Chemistry of Mood, Motivation and Memory which was held at the University of Dosis, San Francisco transsexuell October, The conference was sponsored and supported by the Division of Dosis Education dosis Health Sciences.

We thank Dr. Ruben Dixon and his staff for help in planning the conference and dozis attending to all of the organizational transsexuell. We are grateful to her for her tireless, efficient and productive hormome. We hope that transsexuell volume will help to stimulate further interest as well as understanding dosis the biochemical bases of our behavior.

James L. Agranoff, Horjone. Barondes, M. Berger, Hormone. Anthony Deutsch, Ph. Editors and affiliations. McGaugh 1 1. Buy options.

N Engl J Med. Comparison of the Hershberger assay and androgen receptor binding assay of twelve chemicals. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects. Risk of meningioma among users of high doses of cyproterone acetate as compared with the general population: evidence from a population-based cohort study.

Br J Clin Pharmacol. Medicines and Healthcare Products Regulatory Agency. High-dose cyproterone acetate: potential risk of multiple meningiomas. Growth of a meningioma in a transsexual patient after estrogen-progestin therapy. Gender dysphoria services: a guide for general practitioners and other healthcare staff. Sex Relation Ther. Estrogen plus progestin and the risk of coronary heart disease.

Is progestin an independent risk factor for incident venous thromboembolism? A population-based case-control study. Thromb Res. Spack NP. Management of transgenderism. Irwig MS. Curr Opin Endocrinol Diabetes Obes. Serving transgender people: clinical care considerations and service delivery models in transgender health. Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: a review. Priorities for transgender medical and healthcare research.

Gooren L, Lips P. Conjectures concerning cross-sex hormone treatment of aging transsexual persons. Transgender care by endocrinologists in the United States. Endocr Pract. Barriers to healthcare for transgender individuals. People with gender dysphoria who self-prescribe cross-sex hormones: prevalence, sources, and side effects knowledge. Physical and hormonal evaluation of transsexual patients: a longitudinal study.

Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence. Sex Med. Visceral fat accumulation is an important determinant of PAI-1 levels in young, nonobese men and women: modulation by cross-sex hormone administration. Arterioscler Thromb Vasc Biol.

Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol Oxf ; 58 — Clinical review: breast development in trans women receiving cross-sex hormones. Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens.

Thornton MJ. Human skin: a mirror for estrogen action? Hormone therapy in transgender adults is safe with provider supervision; a review of hormone therapy sequelae for transgender individuals. J Clin Transl Endocrinol. Estrogens, progestogens and thrombosis. J Thromb Haemost. Venous thromboembolism: a public health concern. Am J Prev Med. Lifetime risk of venous thromboembolism in two cohort studies.

Am J Med. Sandset PM. Mechanisms of hormonal therapy related thrombosis. Thrombotic issues in transgender medicine: a review. Am J Hematol. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol Oxf ; 47 — Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy. Fertil Steril. Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist.

Long-term evaluation of cross-sex hormone treatment in transsexual persons. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. Risk of venous thrombosis in persons with increased body mass index and interactions with other genetic and acquired risk factors.

Cauley JA. Estrogen and bone health in men and women. Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones.

Clin Endocrinol Oxf ; 48 — Low bone mass is prevalent in male-to-female transsexual persons before the start of cross-sex hormonal therapy and gonadectomy. Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study. Osteoporos Int. Severe osteoporosis with multiple vertebral fractures after gender reassignment therapy—is it male or female osteoporosis?

Gynecol Endocrinol. Mortality and morbidity in transsexual patients with cross-gender hormone treatment. Interpreting laboratory results in transgender patients on hormone therapy.

Arch Intern Med. Effect of injectable and oral contraceptives on serum lipids. Cross-sex hormone therapy alters the serum lipid profile: a retrospective cohort study in transsexuals. Effect of sex steroids on lipids, venous thromboembolism, cardiovascular disease and mortality in transgender individuals: a systematic review and meta-analysis.

April 1—4, ; FRI— Mental health and gender dysphoria: a review of the literature. Int Rev Psychiatry. Hormonal therapy is associated with better self-esteem, mood, and quality of life in transsexuals.

J Nerv Ment Dis. Hormone-treated transsexuals report less social distress, anxiety and depression. Is hormonal therapy associated with better quality of life in transsexuals? A cross-sectional study. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgend Health. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes.

Clin Endocrinol Oxf ; 72 — Mortality among veterans with transgender-related diagnoses in the Veterans Health Administration, FY— LGBT Health. Sociodemographic characteristics and psychological adjustment among transsexuals in Spain. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol. Psychiatric diagnoses and risk of suicide in veterans.

Arch Gen Psychiatry. Five new cases of breast cancer in transsexual persons. Incidence of breast cancer in a cohort of 5 transgender veterans. Breast Cancer Res Treat.

Breast cancer in male-to-female transsexuals: use of breast imaging for detection. Metastatic prostate cancer in transsexual diagnosed after three decades of estrogen therapy. National Center for Biotechnology Information , U. Journal List Clinics Sao Paulo v. Clinics Sao Paulo.

Published online Apr Author information Article notes Copyright and License information Disclaimer. E-mail: moc. Received Jul 16; Accepted Nov 8. This article has been cited by other articles in PMC. Biochemical analysis The fasting glucose levels were determined with an automatic enzymatic colorimetric method using hexokinase Cobas Integra; Roche, Basel, Switzerland. Statistical analysis The nonparametric Wilcoxon test was used to compare the hormone levels before and after treatment.

Table 1 Serum hormone levels of 51 transgender women before and after 6 months of low-dose estrogen therapy with or without cyproterone acetate. Open in a separate window. CA: cyproterone acetate; CSH: cross-sex hormone.

Table 2 Serum hormone levels after 6 months of treatment with different doses of conjugated equine estrogen alone or with cyproterone acetate in transgender women. CEE: conjugated equine estrogen; CA: cyproterone acetate. Table 3 Serum hormone levels in transgender women after 6 months of conjugated equine estrogen therapy with or without cyproterone acetate therapy.

Footnotes No potential conflict of interest was reported. Transsexualism: a review of etiology, diagnosis and treatment. J Psychosom Res. The DSM diagnostic criteria for gender identity disorder in adolescents and adults.

Arch Sex Behav. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects. Gooren LJ. Clinical practice. Care of transsexual persons. N Engl J Med. Spironolactone with physiological female steroids for presurgical therapy of male-to-female transsexualism.

Medical management of adult transsexual persons. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. Mortality and morbidity in transsexual patients with cross-gender hormone treatment. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones.

Eur J Endocrinol. Cardiovascular disease in transsexual persons treated with cross-sex hormones: reversal of the traditional sex difference in cardiovascular disease pattern. Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: a review. Clinical practice guidelines for assessment and treatment of transsexualism.

Drescher J. Int Rev Psychiatry. Lawrence AA. Gender assignment dysphoria in the DSM Endocrine intervention for transsexuals. Estrogen-induced prolactinoma in a man. Prolactin-producing pituitary adenoma in a male-to-female transsexual patient with protracted estrogen administration.

A morphologic study. Arch Pathol Lab Med. Lactotroph hyperplasia in an estrogen treated male-to-female transsexual patient. Hyperkalemia, an often symptomless condition, can cause serious kidney problems, including renal failure, and heart problems, including difficult to cure cardiac rhythm disturbances. People using spironolactone are advised to avoid excessive potassium in their diets, including salt substitutes containing potassium chloride.

Only a testosterone ester is necessary, unless one is taking testosterone undecanoate, in which case a progestogen may be supplemented. Taking only a testosterone is preferred to avoid the requirement of progestogen, and because they are more widely available.

Hormone regimens for transmen are less complicated, and there are fewer drugs to choose from, apparently reducing the temptation to play the armchair pharmacist.

A review of twenty-seven responses to an online survey of FTM hormone use and surgery indicate most are taking low to normal amounts of testosterone, and none of the 27 reviewed were taking anti-estrogens or progestogens. FTM Survey. Websites from non-medical sources give information on recommended or typical dosage of testosterone. A variety of products marketed to body builders as nutritional supplements are popular among transmen as alternatives to testosterone.

As a result, in the amounts sufficient to produce masculinizing effects, there is a risk of liver damage, particularly when taking these products orally. Of eleven survey respondents who used DHEA without testosterone, no one reported more than slightly noticeable results. Three respondents using large quantities of norandrostenediol and androstendiol had some noticeable results within two to fifteen months. An elevated plasma level of total free and protein-bound homocysteine tHcy is a risk factor independent of other known risk factors for cardiovascular disease.

This combination suggests that transsexual men are at higher risk of cardiovascular disease. An article dealing specifically with the risks of self-treatment by transsexual men noted higher levels of total cholesterol, LDL cholesterol, and triglycerides.

Becerra Fernandez et al However, the higher levels of cholesterol and triglycerides were still within normal levels Citkowitz , Isley An article dealing specifically with the risks of self-treatment by transsexual men also noted elevation of liver enzymes Becerra Fernandez et al The liver enzyme abnormalities in a study that included both MTFs and FTMs were attributed to other causes, such as alcohol abuse and hepatitis B, and were mainly successfully treated, either with other medications or temporarily halting hormone treatment Asscheman el al.

An article dealing specifically with the risks of self-treatment by transsexual men noted increased rates of hyperprolactinemia Becerra Fernandez et al Possible side effects of testosterone use include polycythemia, or having too many red blood cells, and suppression of some clotting factors.

Polycythemia can kill by thrombosis or hemorrhage. Suppression of clotting factors, particularly when combined with the use of anticoagulants, can also result in hemorrhage. Adenoma — A benign tumor in the epithelial tissue—the tissue covering the insides and outsides of parts of the body— in which the cells of the tumor form glandular structures or in which the cells come from glandular epithelium.

Anabolic steroids — Any of a group of synthetic derivatives of testosterone, having pronounced anabolic properties and relatively weak androgenic properties, which are used mainly to promote growth and repair body tissues. Cyproterone acetate — An agent with anti-androgen and progesterone-releasing properties.

It competes at the receptor sites with androgens and reduces their effects. DHEA — An androgenic steroid hormone secreted largely by the adrenal cortex and found in human urine, or synthetic preparation of this hormone used as a nutritional supplement. DHT — Dihydrotestosterone. An androgen derived from testosterone and having tumor-suppressing capabilities useful in the treatment of certain breast cancers.

Estrogen — A generic term for any of a number of female sex hormones. Estrogen is formed in ovaries and testes, has various functions in both sexes, and in females causes the development of secondary sex characteristics. It is used in oral contraceptives, to relieve discomfort of menopause, and to treat osteoporosis and breast and prostate cancer. Homocysteine — An amino acid used normally by the body in cellular metabolism and the manufacture of proteins.

Elevated concentrations in the blood are thought to increase the risk for heart disease by damaging the lining of blood vessels and enhancing blood clotting. Phytoestrogen — A naturally occurring compound of plants, such as soybeans, or plant products, such as whole grain cereals, that acts like estrogen in the body.

Progestogen — A term applied to any substance capable of stimulating the uterine changes essential for implantation and growth of a fertilized ovum. Spironolactone — A steroid derivative that blocks the action of aldosterone, steroid hormone that regulates the salt and water balance in the body. Used as a diuretic primarily in the treatment of hypertension.

Testosterone — Male sex hormone secreted by the testes and responsible for triggering the development of sperm and of many secondary sexual characteristics.

Thromboembolism — Obstruction of a blood vessel with a clot of fibrin— an elastic, insoluble, whitish protein— carried by the blood stream. Thrombosis — Formation of a thrombus— platelets, fibrin, and pieces of other cells— that obstruct a blood vessel at the place where the thrombus is formed. Goserelin Acetate Pre-op 3. Hormone treatment in transsexual people. New York: Haworth Press. Prolactin levels and pituitary enlargement in hormone-treated male-to-female transsexuals.

Clin Endocrinol Oxf. Mortality and morbidity in transsexual patients with cross-gender hormone treatment. Abstract retrieved 18 May from PubMed. Citkowitz E. Futterweit W. Endocrine therapy of transsexualism and potential complications of long-term treatment. Arch Sex Behav. Follow-up of prolactin levels in long-term oestrogen-treated male-to-female transsexuals with regard to prolactinoma induction.

Dtsch Med Wochenschr. Abstract retrieved 19 May from PubMed. Hormone Therapy for F2M Transsexuals. RxList Medical Terminology. Isley W. Hypercholesterolemia, Polygenic. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Prolactin-producing pituitary adenoma in a male-to-female transsexual patient with protracted estrogen administration.

A morphologic study. Arch Pathol Lab Med. Lawrence A. Some typical hormone regimens. The effects of oestrogen exposure on bone mass in male to female transsexuals. Clinical Endocrinology. Rohr UD. A follow-up study for estimating the effectiveness of a cross-gender hormone substitution therapy on transsexual patients.

Categories: Hormones. Im a transpinay,a filipino transgender. I am on microgynon… Also 1 pill daily. And Yes it is safe… I would like to try to take 2 pills daily… Because its necessary to reach 0.

And my pill also have only 0. But I would take Microgynon instead of Diane35… Lori. Do I need to skip 7 days after cosnsuming all 21 tabs for 21 days? Or just continue taking daily? Made me hungry all the time, blood pressure skyrocketed, and made me 5 acne in 5 days, and my face is perfectly clear normally.

Much better, less hungry, acne are all gone in 48 hours, blood pressure lowered. And progesterone 10 days at beginning of every month-. The website TransHealth did an informal survey of self-medicating transwomen, and […]. Also, is there a bigger concern with overweight or obese patients? Would I likely see better feminization if I were switched to weekly injections of the same dose? I am also on a low dose of Spiro 25mg daily, all of which is prescribed by my endocrinologist.

Thank you for your time! Possibly Amy. What concentration is your EV? I have commented below on my experience with EV and being able to drop spiro. Can anyone tell me a place on the internet where I can get testosterone blocker and estrogen without a prescription for a good price?

I live in the usa. I want to feminize my body so much. M injection and mg flutamide three times daily. Finding information regarding transgender HRT that has detailed information from dose to side effects based on medical and non-medication resources is extremely difficult to find.

It was insightful and refreshing. I have been self-medicating for over ten years. If this sounds agnsty, it is because it is.

I came to this conclusion while I was a teenager still hiding my dysphoria from my parents.

transsexuell hormone dosis

The ideal dosage of cross-sex hormones remains unknown. The aim of this study was to evaluate the luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin levels after low-dose estrogen therapy with or without cyproterone acetate doosis transgender women. Transsexuell serum hormone and biochemical profiles of 51 transgender women were evaluated before gonadectomy.

Hormone therapy consisted of conjugated equine estrogen alone or combined with cyproterone acetate. The daily dose of conjugated equine estrogen was 0. Estrogen-only therapy reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from The serum levels transsexuell luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin in the patients treated with estrogen alone and estrogen plus cyproterone acetate were not significantly different.

The group receiving estrogen plus cyproterone acetate had significantly higher levels of gamma-glutamyltransferase than the group receiving estrogen alone. No significant differences in the other biochemical parameters were evident between the patients receiving estrogen alone and estrogen plus cyproterone acetate. In our sample of transgender women, lower estrogen doses than those usually prescribed for these subjects were able to adjust the testosterone dosis estradiol levels to the physiological female range, thus avoiding high estrogen doses and their multiple associated side effects.

Transgender women TW have a female gender identity and desire to live as a member of the female community 1. Cross-sex identification typically has an early onset and causes chronic suffering. To alleviate the distress associated with belonging to an undesired gender group, sex reassignment hormone transsexuell is indicated and must be preceded by a thorough psychological evaluation to establish the diagnosis of gender dysphoria 2.

Hormone therapeutic process for TW includes three mainstays: psychotherapy, hormone therapy and sex reassignment surgery 3. During the process of changing from the tramssexuell to the female phenotype, TW require the administration of cross-sex hormones to mitigate the phenotypic signs of the male biological sex and to develop female characteristics. After hormone therapy, expected physical changes include breast development and the redistribution of body fat to a female pattern, as well as a decrease in facial hair growth, body hair growth, muscle mass, testicular volume and spontaneous erections transsexuuell.

The aim of hormone therapy in TW is to hormmone the development of female phenotypic characteristics using the lowest effective estrogen doses to maintain serum estradiol E2 and testosterone T levels within the normal range for women in the follicular phase of the menstrual cycle 35.

The treatment regimen of Dosis usually consists of estrogen combined with a compound that suppresses androgen actions, such as spironolactone, finasteride, flutamide or cyproterone acetate CA 3.

Spironolactone has a synergistic effect with estrogen on physical changes 6. Finasteride and flutamide are rarely used; dosis efficacy of finasteride is limited, and flutamide is associated with liver toxicity 7. CA is the most commonly used antiandrogen drug in Europe and South America.

CA acts as a potent competitive antagonist of the androgen receptor and has additional progestational activity, inhibiting luteinizing hormone LH release 8. Different estrogen compounds and routes of administration exist for cross-sex hormone treatment. The use of oral ethinyl E2 in transsexuals is associated with an increased risk of venous thromboembolism and death from cardiovascular events 9 The recommended estrogenic doses for feminization of TW, according to the Endocrine Society guidelines, are usually three times higher than those used for hormone replacement therapy in postmenopausal women and are similar to those used in hypogonadal patients 3 Transsexuell retrospectively analyzed the effects of lower doses of estrogen in TW on suppressing endogenous T hormond maintaining the physiological levels of E2 within the normal dosis for premenopausal women in the follicular transexuell.

All patients consulting in our Transsexual Unit with biochemical and hormonal data before and 6 months after therapy were invited to participate in this retrospective analysis, and of the 58 patients who were invited, 51 agreed to participate.

The mean age at the first evaluation was All patients had a normal male phenotype 46, XY chromosome karyotypedossis none of them had previously undergone an orchiectomy. The daily doses of dosks were 0. The fasting glucose levels were determined with an automatic enzymatic colorimetric method using hexokinase Cobas Integra; Transsexuell, Basel, Switzerland. Hoffmann-La Roche, Basel, Switzerland. The nonparametric Wilcoxon test was used to compare the hormone levels before and after treatment.

The nonparametric Mann-Whitney test was used to compare the different treatments. In this group of patients, four subjects received 0. Serum hormone levels of 51 transgender women before and after 6 months of low-dose estrogen therapy with or without cyproterone acetate. Normal value for premenopausal women at the follicular phase of the menstrual cycle: LH, 2.

Serum hormone levels after 6 months of treatment with different doses of conjugated equine estrogen alone or with cyproterone acetate in transgender women.

Thirty-seven subjects received 0. After comparing these two CEE subgroups, we observed that both treatments were able to suppress the T levels to within the normal female range 22 vs The values were Serum hormone levels in transgender women after 6 months of conjugated equine estrogen therapy with or transssxuell cyproterone acetate therapy.

TW generally have a psychological need to increase estrogen replacement doses to acquire a female phenotype as soon as possible. A higher estrogen dose is associated with an increased risk of venous thromboembolic disease, pulmonary embolism, myocardial infarction, stroke, hormone-related tumors and dsis liver effects trabssexuell In addition to these common side effects of high-dose estrogen therapy, increases in PRL levels hormond even prolactinoma development have been described in TW 18 - The ideal dosage of cross-sex hormones is still unknown because randomized controlled trials in this specific transgender population are not available.

The multiple types of estrogens, variability of their measurement and different hormone of administration make the standardization of therapeutic hormone difficult. Long-term follow-up studies of hormone treatment in transsexuals and of hormone replacement therapy in biological females are used to guide cross-sex hormone therapy in TW 3.

The use of a synthetic estrogen, ethinyl E2, in a large cohort of transsexiell has been associated with hoemone increased risk of cardiovascular and thromboembolic hormone. Interestingly, the vast majority of these adverse events occur during the first year of estrogen treatment, and the risk is higher in patients older than 40 years 9 Natural estrogens are safer options than synthetic estrogens for cross-sex dosis treatment 11 - Transdermal preparation is the safest form of estrogen administration, especially in transsexual patients who smoke or have diabetes because the hormone preparation does not influence protein, lipoprotein or triglyceride synthesis, thereby reducing the thrombotic and cardiovascular risks 3.

In our hospital, transsexual patients are treated by a multidisciplinary group and receive psychological support before and after surgery. The psychological support transsexell the anxiety of the patients as they develop the female phenotype and allows us to treat our patients with the lowest estrogen doses necessary to normalize androgen and estrogen levels.

This study is the first to evaluate the use of low trabssexuell of estrogens in TW. We have demonstrated that low estrogen bormone alone or with CA are effective toward maintaining androgen suppression and serum E2 within the normal follicular-phase range.

Evaluations of the effects of low-dose estrogen therapy on physical changes, namely, breast development, hornone hair growth, body hair growth and body trannssexuell redistribution, were not possible in our patient population because all of the patients reported prior use of other estrogen formulations without medical supervision for a variable period of time.

However, the maintenance of estrogen levels in the normal female range suggests dosis low-dose estrogen therapy may be able to promote the satisfactory feminization of these patients.

The facial jormone response to hormonal treatment in transsexuals, hormone at high estrogen doses, is very poor and often requires complementary cosmetic treatments such as laser transaexuell and electrolysis. The use of CA is especially important to alleviate androgenic signs and symptoms such as the male pattern of facial hormonne body hair and the undesired spontaneous penile erections frequently reported by TW.

In our analysis, we hormone that CA was not critical for achieving androgen suppression and transsexuell estrogen alone, even at low doses, was effective toward suppressing the hypothalamic-pituitary-testicular axis 8 transsexkell, Even so, we observed that the regimen comprising estrogen plus CA achieved dosis more potent suppression of LH levels than the regimen containing estrogen alone from 6.

In our clinical practice, we avoid daily doses higher than 50 mg of CA because of transsexuelll potential metabolic side effects, including weight gain and high blood pressure. We observed that the GGT levels were higher in the group receiving dosis plus CA than in the group receiving estrogen alone, although the both groups presented with GGT levels in the normal range.

In our cohort, the estrogen levels before and after cross-sex hormone treatment were not dosie different. The conversion of male levels of T to estrogen before treatment was similar to that achieved by the low-dose estrogen treatment Estrogen-induced increases in PRL levels in many physiological conditions, such as pregnancy and puberty, are well known, and a mild increase in PRL levels in TW has been described after estrogen therapy granssexuell Similarly, dois PRL levels were identified in dosis cohort after low doses of estrogen therapy.

Although these levels were not statistically significant in the group that received hormohe alone, a significant increase was observed in the group cosis estrogen plus CA.

Our results demonstrated that the different doses of CEE 0. Additionally, we observed that the two different doses of CEE had similar effects on hormone levels after 6 months of treatment. However, these data should be hotmone with caution because the number of individuals trxnssexuell each subgroup is very small, thus reducing the statistical transsexuelll of the sample.

In conclusion, in our sample of TW, lower estrogen doses tramssexuell those usually prescribed for these subjects were able to adjust the T and E2 levels to the physiological female range, avoiding the risks of high estrogen doses. Cunha FS and Sircili Trqnssexuell transsexuell responsible for the acquisition and analysis of data, and manuscript drafting.

No potential conflict of interest was reported. National Center for Biotechnology InformationU. Journal List Clinics Sao Paulo v. Hormone Sao Paulo. Published online Apr Author information Article notes Hranssexuell and License information Disclaimer. E-mail: moc. Received Jul 16; Accepted Nov 8. This article has been cited by other articles in PMC. Biochemical traanssexuell The fasting glucose levels were determined with an automatic enzymatic colorimetric method using hexokinase Cobas Integra; Roche, Basel, Switzerland.

Statistical analysis The nonparametric Wilcoxon test was hormone to compare the hormone levels horomne and after treatment. Dosis 1 Serum hormone levels of 51 transgender women before and after 6 months of low-dose estrogen therapy with or without cyproterone acetate. Open hormone a separate window. CA: trranssexuell acetate; CSH: cross-sex hormone. Table 2 Serum hormone levels after 6 months of treatment with different doses of conjugated equine estrogen alone or with cyproterone acetate in transgender women.

CEE: conjugated equine estrogen; CA: cyproterone acetate. Table 3 Serum hormone levels in transgender women after 6 months of conjugated transsexuell estrogen therapy with or without cyproterone acetate therapy. Footnotes No potential conflict of interest transsexuell reported. Transsexualism: a review of etiology, diagnosis and treatment. J Psychosom Res. The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Arch Sex Behav. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline.

J Clin Endocrinol Metab. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects.

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They often seek hormone therapy, with or without surgery, . for endocrine treatment of transsexual people presents an overview of the. Achtung: Wir raten mit Nachdruck davon ab, Hormone ohne ärztliche . of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People,​.

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