Endocrine treatment of transgender individuals

[madman]

Endocrine treatment of transgender individuals: current guidelines and strategies



Abstract

Introduction: This review provides a summary of the medical and surgical care available to transgender individuals, as well as to offer proposals on how the medical field can progress to provide medically and culturally appropriate care.

Areas covered: Transgender individuals are defined as those whose gender identity differs from that recorded at birth (usually based on visualization of their external sexual anatomy). In order to align the body with the patient’s gender identity, clinicians can provide hormone therapy (HT) either to suppress endogenous sex hormone secretion, to bring sex hormone levels to the range associated with the patient’s gender identity, or both. Once at steady-state, regular monitoring for maintenance of levels, as well as for known risks and complications, is required. The treating clinicians should have knowledge of trans assessment criteria, hormone therapy, surgical options, primary care, and mental health needs of transgender patients. A narrative literature review was conducted using Pubmed and EMBASE with articles then selected for relevance. The following search terms were used initially: androgen suppression, antiandrogen, breast development, chest reconstruction, cisgender, estrogen, fertility preservation, gender-affirming surgery, gender identity, gender incongruence, genital reconstruction, hormone replacement, hyperlipidemia, orchiectomy, prolactin, prostate atrophy, spermatogenesis, spironolactone, testosterone, thrombogenesis, transgender, and virilization.

Expert opinion: Although guidelines exist and examples of high-quality training are readily available, to truly mainstream appropriate high-quality gender-affirming health care there must be a move towards implementing systematic formal training.




Article highlights

• Hormone therapy for transgender men includes testosterone administration to stimulate physical changes consistent with the patient’s gender identity

• Hormone therapy for transgender women includes estrogen and androgen-suppressing agents to stimulate physical changes consistent with the patient’s gender identity

• Associated risks with these therapies must be considered, and routine monitoring dependent on the specific therapy administered is recommended

• In addition to hormone therapy, there are several surgical options available for both transgender men and women to supplement hormone replacement therapy in optimizing these physical changes

• A multi-disciplinary team approach is required to tailor therapy to the individual in achieving their gender identity goals

• Advancement in the management of transgender individuals requires an intentional effort to include training for all providers




2. Hormone regimens for transgender men

2.1 Treatment effects
2.2 Medical risks/safety
2.3 Monitoring

3. Hormone regimens for transgender women

3.1 Treatment effects
3.2 Medical risks/safety
3.3 Monitoring

4. Surgical options


5. Expert Opinion

5.1 Advancement in the medical management of transgender individuals requires an intentional effort to include training for all providers

 

[madman]

Table 1. Common Terminology

 

[madman]

Table 2. Hormone Regimens for Transgender Men

 

[madman]

Table 3. Monitoring Transgender Men on Hormone Replacement Therapy

 

[madman]

Table 4. Hormone Regimens for Transgender Women

 

[madman]

Table 5. Monitoring Transgender Women on Hormone Replacement Therapy

 

[madman]

Table 6. Surgical Options for Transgender Patients

 

[Nelson Vergel]

Estrogen therapy boosted immune function in transgender women (male to female transgender people)


The article titled "Impact of hormonal therapy on HIV-1 immune markers in cis women and gender minorities" investigates how hormonal therapy affects HIV-1 immune markers in cis women (CW) and trans women and non-binary people (TNBP) with HIV. Here are the key findings:

1. Study Population and Methods:
   • The study included 54,083 measurements from 3,092 CW and 83 TNBP, and 147,230 measurements from 8,611 cis men (CM).
   • Hormonal therapy use was assessed using specific ATC codes, and the effects on CD4, CD8, and lymphocyte counts, as well as the CD4:CD8 ratio, were analyzed using linear mixed-effects models.
2. Key Results:
   • CD4 Count and CD4:CD8 Ratio: Hormonal therapy use significantly increased CD4 counts and the CD4:CD8 ratio in TNBP more than in CW. TNBP with hormonal therapy had higher median CD4 counts (772 cells/μL) compared to those without (617 cells/μL).
   • Inflammatory Markers: No significant changes in serum protein concentrations were observed in TNBP before and after hormonal therapy use.
   • Comparison with Cis Men: The effect of hormonal therapy on CD4 counts in TNBP was similar to the difference in CD4 counts between CW and CM, but this was not observed for other markers like CD8 counts and lymphocytes.
3. Conclusion:
   • The study highlights the potential role of hormonal therapy in modulating the immune system, particularly in TNBP with HIV. It suggests that hormonal therapy use is associated with increased CD4 counts in TNBP, which cannot be solely explained by better adherence to treatment or viral control.
4. Limitations:
   • The study is observational, so causality cannot be established.
   • Gender identity was not directly available for all participants, and the identification of TNBP relied on indirect data.
   • The study did not include longitudinal modeling of immune trajectories or measures of sex hormone levels.