Abstract
Transsexual patients often have difficulty finding care because many physicians are not comfortable prescribing appropriate hormone regimens. Management of hormones for transsexual patients is not difficult, and these medications are safer than many therapies routinely prescribed by the primary care physician. The diagnosis of gender identity disorder (GID) must be established by an experienced mental health professional prior to consideration for hormonal management. Medical evaluation includes a thorough medical history, social history, family history, physical examination, and basic laboratory screening. If there are no medical contraindications, a variety of regimens for the male-to-female transsexual may be initiated, with initial close follow-up for medical and psychological well-being. There is less variation in female-to-male management with testosterone, but initial frequent follow-up is equally important. This review is intended to teach primary care providers how to initiate and maintain hormone regimens for transsexual patients and describe medical issues unique to transsexual patients.
Similar content being viewed by others
REFERENCES
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994.
Seil D. Transsexuals: The boundaries of sexual identity and gender. In: Cabaj RP, Stein TS, editors. Textbook of Homosexuality and Mental Health. Washington, DC: American Psychiatric Press, 1996:743.
The Standards of Care for Gender Identity Disorders. Harry Benjamin International Gender Dysphoria Association. 1998.
Schlatter K, Von Werder K, Stalla GK. Multistep treatment concept of transsexual patients. Exp Clin Endocrinol Diabetes 1996;104:413-19.
Futterweit W. Endocrine management of transsexual. New York State J Med 1980;80:1260-64.
Prior JC. Hormonal therapy of gender dysphoria: The female-to-male transsexual. In: Dallas Denny, editor. Current Concepts in Transgender Identity. New York: Garland Publishing Inc., 1998.
Asscheman H, Gooren LJG, Eklund PLE. Mortality and morbidity in transsexual patients with cross-gender hormone treatment. Metabolism 1989;38:869-73.
Goh HH, Loke DF, Ratnam SS. The impact of long-term testosterone replacement therapy on lipid and lipoprotein profiles in women. Maturitas 1995;21:65-70.
Giltay EJ, Hoogeveen EK, Elbers JMH, et al. Effects of sex steroids on plasma total homocysteine levels: A study in transsexual males and females. J Clin Endocrinol Metab 1998;83:550-53.
Rosenmund A, Kochli HP, Konig MP. Sex-related differences in hematological values. A study on the erythrocyte and granulocyte count, plasma iron, and iron-binding proteins in human transsexuals on contrasexual hormone therapy. Blut 1998;56:13-7.
Coulam CB, Annegers JF, Kranz JS. Chronic anovulation syndrome and associated neoplasia. Obstet Gynecol 1983;61: 403-7.
Pache TD, Chadha S, Gooren LJ, et al. Ovarian morphology in long-term androgen-treated female to male transsexuals. Histopathology 1991;19:445-52.
Spinder T, Spijkstra JJ, van den Tweel JG, et al. The effects of long term testosterone administration on pulsatile luteinizing hormone secretion and on ovarian histology in eugonadal female to male transsexual subjects. J Clin Endocrin Metab 1989;69:151-7.
Futterweit W, Weiss RA, Fagerstrom RM. Endocrine evaluation of forty female-to-male transsexuals: Increased frequency of polycystic ovarian disease in female transsexualism. Arch Sex Behav 1986;15:69-78.
Balen AH, et al. Polycystic ovaries are a common finding in untreated female to male transsexuals. Clin Endocrin 1993;38:325-9.
Futterweit W. Endocrine therapy of transsexualism and potential complications of long-term treatment. Arch Sex Behav 1998;27:209-26.
Van Kesteren PJM, Lips P, Deville W, et al. The effect of one-year cross-sex hormonal treatment on bone metabolism and serum insulin-like growth factor-1 in transsexuals. J Clin Endocrin Metab 1996;81:227-32.
Schlatterer K, Auer DP, Yassouridis A, et al. Transsexualism and osteoporosis. Exp Clin Endocrinol Diabetes 1998;106: 365-8.
Jequier AM, Bullimore NJ, Bishop MJ. Cyproterone acetate and a small dose of oestrogen in the pre-operative management of male transsexuals. Andrologia 1989;21:456-61.
van Kesteren PJM, Asscheman H, Megens JAJ, Gooren LJG. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrin 1997;47:337-42.
Kwan M, Van Massdam J, Davidson JM. Effects of estrogen treatment on sexual behavior in male-to-Female transsexuals: Experimental and clinical observations. Arch Sex Behav 1985;14:29-40.
Reutrakul S, Ongphiphadhanakul B, Paisue N, et al. The effects of oestrogen exposure on bone mass in male to female transsexuals. Clin Endocrin 1998;49:811-4.
Orentreich N, Durr NP. Mammogenesis in transsexuals. J Invest Dermatol 1974;63:142-6.
Biller J, Saver JL. Ischemic cerebrovascular disease and hormone therapy for infertility and transsexualism. Neurology 1995;45:1611-3.
Lehrman KL. Pulmonary embolism in a transsexual man taking diethylstilbestrol. JAMA 1976;235:523-33.
Ganly I, Taylor W. Breast cancer in a trans-sexual man receiving hormone replacement therapy. Br J Surg 1995;82:341.
Pritchard TJ, Pankowsky DA, Crowe FP, et al. Breast cancer in a male-to-female transsexual. A case report. JAMA 1988;259:2278-80.
Asscheman H, Gooren LJG, Assies J, et al. Prolactin levels and pituitary enlargement in hormone-treated male-to-female transsexuals. Clin Endocrin 1988;28:583-8.
Goh HH, Ratnam SS. Effect of estrogens of prolactin secretion in transsexual subjects. Arch Sex Behav 1990;19:507-16.
Gooren LJG, Harmsen-Louman W, Van Kessel. Follow-up of prolactin levels in long-term oestrogen-treated male-to-female transsexuals with regard to prolactinoma induction. Clin Endocrin 1985;22:201-7.
Prior JC. Hormonal therapy of gender dysphoria: The male to-female transsexual. In: Dallas Denny, editor. Concepts in Transgender Identity. New York: Garland Publishing Inc., 1998.
Prior JC, Vigna YM, Watson D. Spironolactone with physiological female steroids for presurgical therapy of male-to-female transsexualism. Arch Sex Behav 1989;18:49-57.
de Vries CP, Gooren LJ, van der Veen EA. The effect of cyproterone acetate alone and in combination with ethinylestradiol on the hypothalamic pituitary adrenal axis, prolactin and GH release in male-to-female transsexuals. Horm Metab Res 1986; 18:203-6.
Kirk S. Feminizing Hormonal Therapy for the Transgendered. Pittsburgh: Together Lifeworks, 1999.
Put Prevention into Practice: Clinician's Handbook of Preventive Services, 2nd ed. U.S. Department of Health and Human Services, 1998.
VanKesteren PJM, Asscheman H, Megens JAJ, et al. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrin 1997;47:337-42.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Oriel, K.A. Clinical Update: Medical Care of Transsexual Patients. Journal of the Gay and Lesbian Medical Association 4, 185–194 (2000). https://doi.org/10.1023/A:1026563806480
Issue Date:
DOI: https://doi.org/10.1023/A:1026563806480