There is as yet no true insight into the effects of cross-sex hormone treatment on cardiovascular health. Care of Transsexual Persons. The skewed sample toward transgender men could be due to secular trends or due to exclusion of sequentially presenting transgender women who had been on previously self-directed hormone therapy. Elevated median baseline body mass index in transgender men is consistent with a prior Japanese study which found an increased prevalence of metabolic disorders and the polycystic ovarian syndrome PCOS in this population. Androgen blockers can help reduce doses of hormones needed. Getting a prescription and doing it supervised is often cheaper, safer, and more effective than black market options. The issue seems less pressing in F2M receiving treatment with testosterone because in this group there is no high risk of androgen-related malignancies. Since its initiation in , female-to-male F2M and male-to-female transsexuals M2F have received hormonal treatment.
Changes over 4—12 months in risk factors for cardiovascular disease in M2F transsexuals. Single-dose pharmacokinetics of sublingual versus oral administration of micronized 17 beta-estradiol. Androgen blockers allow the use of lower estradiol dosing, in contrast to the supraphysiologic estrogen levels and associated risks previously used to affect pituitary gonadotropin suppression. Recommendations for early diagnosis and prevention are presented. Feminizing hormone therapy also brings about changes in emotional and social functioning. An unresolved question is whether in the long term all functions of sex steroids of a subject are adequately covered by cross-sex hormones and whether the administration of cross-sex hormones is appropriately safe, or at least as safe as administration of sex steroids in a subject receiving long-term sex-appropriate sex steroids. Part of testosterone is converted to estradiol, resulting in circulating estradiol levels well above the plasma level of estradiol critical for preserving bone mineral density in men i. Cross-sex hormone therapy alters the serum lipid profile: Cross-sex hormone treatment of transsexuals seems acceptably safe over the short and medium term, but solid clinical data are lacking. Spironolactone up to mg twice daily, if tolerated , a diuretic with antiandrogenic properties, has similar effects. Have a preoccupation with stereotypical activities of the opposite sex — as shown by cross-dressing , simulating attire of the opposite sex, or an intense desire to join in the games and pastimes of the opposite sex — and reject stereotypical games and pastimes of the same sex, or Have persistent denial relating to their anatomy. The acquisition of the secondary sex characteristics of the other gender is fundamental to sex reassignment. Adolescents and adults must display a persistent desire to be the other sex, frequent pass as the other sex, desire to live or be treated as the other sex, or believe that they have the typical feelings and reactions of the other sex. There are presently no indications that there are fundamental sex differences in sensitivity to hormone action of sex steroids. Considering these differences in demographics and goals of therapy, extremely modest increase in overall risk, and lack of difference in mortality, as well as more recent reassuring data with other forms of estrogen, the risks of using progestagens in transgender women are likely minimal or even absent Grading: This period is sometimes called real-life experience RLE. They are not a magic pill. Hormone Treatment in Transsexuals. Although the initial treatment with cross-sex hormones is mainly concentrated in specialized centers, complications occurring in the long term are seen in general practice, and these complications are only occasionally reported in the scientific literature. Such findings might help to inform the evaluation of transgender men on testosterone treatment who present with symptoms of bleeding, pelvic pain or other estrogenic features. There is, however, no evidence supporting a causal relation between higher testosterone levels and heart disease An evaluation for testicular neoplasms should be performed with a scrotal exam as well as testing for elevated serum human chorianogonadotropin hCG , lactate dehydrogenase LDH , alpha-fetoprotein AFP levels, and possibly scrotal imaging. Other delivery routes for estradiol such as transdermal gel or spray are formulated for the treatment of menopausal vasomotor symptoms and while convenient and effective in some transgender women, in others these routes may not be able to achieve blood levels in the physiologic female range. In adults and adolescents, it may manifest as a preoccupation with removing primary or secondary sex characteristics through surgery or hormone replacement therapy. The general approach is similar to estrogen replacement in agonadal i.
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