Transgender healthcare and hormone therapy

Question 1

What are the effects of oestrogen treatment?

Answer 1

Hair: some effect on facial hair, mechanical forms of hair removal often still required, more effect on body hair, no effect on ‘lost’ scalp hair but prevents further loss.
Breasts: expect one cup size, gradual oestrogen treatment for optimal breast development otherwise fuse breast buds, maximum effect achieved after 2 years’ treatment.

Question 2

How is oestrogen treatment administered?

Answer 2

Oral or transdermal oestradiol (patch/gel).
GnRH analogue to suppress testosterone - IM injection, not required after gonadectomy.
Venous thromboembolism risk increased - multiplicative risks: smoking, obesity.
Life-long treatment

Question 3

What are the risks and effects of testosterone treatment?

Answer 3

Hair: male-pattern hair growth, scalp hair loss (depending on genetic factors).
Intramuscular or transdermal gel testosterone.
Do not need GnRH analogue.
Risk of polycythaemia: monitor haemoglobin and haematocrit, increased risk in smokers.
Maximum effect achieved after 5 years’ treatment.

Question 4

What are the contraception options?

Answer 4

Trans-male - consider IUD (coil) or depot progesterone if having sex with men (testosterone treatment teratogenic).
HIV screening as indicated.
Relatively higher HIV prevalence in trans-females.

Question 5

Outline the screening options for trans females

Answer 5

Mammography from age 50 once on hormone therapy for 5 years, DEXA at 60, sooner if other risk factors for osteoporosis or if inadequate hormone therapy post-gonadectomy.

Question 6

Outline the screening options for trans males?

Answer 6

Cervical and breast screening as for XX population unless surgically removed, self-examination is recommended,
consider 2-yearly USS endometrium unless surgically removed - risk of hyperplasia.
DEXA at 60.

Question 7

Which drugs can delay puberty?

Answer 7

GnRH analogues