Transgender Medicine
What is transgenderism? - ANS-- Transgender or trans means someone whose gender
differs from the one they were given when they were born
- Transgender people may identify as male or female, or they may feel that neither label
fits them (androgenous)
What is transsexual? - ANS-- People who transition from one sex to another
- A person born as a male can become recognizably female through the use of
hormones and/or surgical procedures and vice versa
- Transsexuals are unable to change their genetics and cannot acquire the reproductive
abilities of the sex to which they transition
What may contribute to a transgender identity? - ANS-- Prenatal hormone levels
- Genetics
- Early childhood experiences
- Etc.
What are the stages of individualized goals when it comes to transitioning? - ANS--
Perception of self
- Perceptions by others
- Hormonal therapy alterations
- Surgical alterations
The basic feedback of hormones: - ANS-- Hypothalamus releases GnRH onto the
anterior pituitary
- Anterior pituitary releases LH and FSH
- LH and FSH stimulated testosterone and estradiol release from the testes
- Testosterone and estradiol feed back negatively onto the hypothalamus and the
pituitary gland
What are the relative contraindications to estrogen therapy? - ANS-Require additional
evaluation and tx prior to initiation of estrogen...
- Hx of breast cancer
- Cardiovascular disease
- Cerebrovascular disease
- Severe liver dysfunction
- Pituitary prolactinoma - should be treated before starting estradiol therapy
, What are the feminizing effects of male-to-female treatment? - ANS-- Redistribution of
body fat
- Decrease in muscle mass and strength
- Softening of the skin/decrease oiliness
- Decreased libido
- Decreased spontaneous erections
- Variable levels of male sexual dysfunction
- Breast growth
- Decreased testicular volume
- Decrease sperm production
- Decreased terminal hair growth
- Scalp hair does NOT regrow
- Voice does NOT change
What are some patient priorities for transgender women? - ANS-- Priorities for many
women include elimination of facial hair growth, induction of breast formation, and a
more female fat/muscle distribution
- A reduction of the biological effects of androgens to normal female levels is required to
meet these goals
What is the approach to anti-androgen and estrogen use in Canada? - ANS--
Anti-androgens: spironolactone (mineralocorticoid receptor antagonist) is the most
widely used drug for MTF transition: it is a competitive inhibitor of the androgen
receptor, as well as an inhibitor of testicular steroidogenesis; the recommended dose is
100-400 mg/day (monitor K+ levels)
- Alternatives include GnRH agonists (given pre-pubertal) to prevent development of
male features
- Estrogen: the usual approach includes estrogen therapy to help suppress endogenous
androgen secretion and to replace it with estrogen, there is a wide range of estrogens
and routes of delivery from which to choose from
What estrogen options are available for trans-women? - ANS-- Transgender women
with intact testes will require relatively high doses of estrogens to suppress testosterone
into the female range, even with an adjunct anti-androgen agent
Typical regimens include:
- Transdermal (gel or patch): 100-200 mcg twice/week
- Oral: 2-4 mg/day, occasionally as high as 6 mg (7-beta estradiol is used most
commonly, but also conjugated estrogens)
What is transgenderism? - ANS-- Transgender or trans means someone whose gender
differs from the one they were given when they were born
- Transgender people may identify as male or female, or they may feel that neither label
fits them (androgenous)
What is transsexual? - ANS-- People who transition from one sex to another
- A person born as a male can become recognizably female through the use of
hormones and/or surgical procedures and vice versa
- Transsexuals are unable to change their genetics and cannot acquire the reproductive
abilities of the sex to which they transition
What may contribute to a transgender identity? - ANS-- Prenatal hormone levels
- Genetics
- Early childhood experiences
- Etc.
What are the stages of individualized goals when it comes to transitioning? - ANS--
Perception of self
- Perceptions by others
- Hormonal therapy alterations
- Surgical alterations
The basic feedback of hormones: - ANS-- Hypothalamus releases GnRH onto the
anterior pituitary
- Anterior pituitary releases LH and FSH
- LH and FSH stimulated testosterone and estradiol release from the testes
- Testosterone and estradiol feed back negatively onto the hypothalamus and the
pituitary gland
What are the relative contraindications to estrogen therapy? - ANS-Require additional
evaluation and tx prior to initiation of estrogen...
- Hx of breast cancer
- Cardiovascular disease
- Cerebrovascular disease
- Severe liver dysfunction
- Pituitary prolactinoma - should be treated before starting estradiol therapy
, What are the feminizing effects of male-to-female treatment? - ANS-- Redistribution of
body fat
- Decrease in muscle mass and strength
- Softening of the skin/decrease oiliness
- Decreased libido
- Decreased spontaneous erections
- Variable levels of male sexual dysfunction
- Breast growth
- Decreased testicular volume
- Decrease sperm production
- Decreased terminal hair growth
- Scalp hair does NOT regrow
- Voice does NOT change
What are some patient priorities for transgender women? - ANS-- Priorities for many
women include elimination of facial hair growth, induction of breast formation, and a
more female fat/muscle distribution
- A reduction of the biological effects of androgens to normal female levels is required to
meet these goals
What is the approach to anti-androgen and estrogen use in Canada? - ANS--
Anti-androgens: spironolactone (mineralocorticoid receptor antagonist) is the most
widely used drug for MTF transition: it is a competitive inhibitor of the androgen
receptor, as well as an inhibitor of testicular steroidogenesis; the recommended dose is
100-400 mg/day (monitor K+ levels)
- Alternatives include GnRH agonists (given pre-pubertal) to prevent development of
male features
- Estrogen: the usual approach includes estrogen therapy to help suppress endogenous
androgen secretion and to replace it with estrogen, there is a wide range of estrogens
and routes of delivery from which to choose from
What estrogen options are available for trans-women? - ANS-- Transgender women
with intact testes will require relatively high doses of estrogens to suppress testosterone
into the female range, even with an adjunct anti-androgen agent
Typical regimens include:
- Transdermal (gel or patch): 100-200 mcg twice/week
- Oral: 2-4 mg/day, occasionally as high as 6 mg (7-beta estradiol is used most
commonly, but also conjugated estrogens)
