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WPATH GEI Day 2
7) Foundations in Hormonal Therapy:
Adults &…
WPATH GEI Day 2
7) Foundations in Hormonal Therapy:
Adults & Adolescents
WPATH GEI Day 3
13) Advanced Hormonal Therapy
(Mats Holmberg)
Bone health
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In studies:
Trans femme have lower BMD than cis men even before starting hormones (may be related to exercise, outdoor)
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Pubertal hormone suppression
(Temporary, buy time)Female puberty
- Starts 2 years earlier
- Ends earlier
Male puberty
- Starts later
- Ends around 25 yo
Begin at Tanner stage 2
ONLY after first exhibit physical changes of puberty
(Make sure puberty has started,
If puberty never started, need to do something else)
GnRH agonists
- Physiologic: GnRH pulsatile - stimulate LH
- Pharmacologic: GnRH daily - LH agonist to antagonist phase
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Fertility preservation
(AFAB: Stop t, on female hormones, retrieve eggs)
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Evidence: May be more difficult to retrieve after on hormones for some time
No evidence: How does it affect sperm and ovum quality
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17-beta estradiolAndrogen blockers (including GnRH agonist)
(bicalutamide: not adequately studied for trans femme, rare hepatotoxicity)Progestins
- No evidence to support the benefits, benefits not outweight risks
- Risks: High prolactin, low HDL, meningioma
- VTE, breast cancer
Possible risk: VTE
- Over 45 yo or previous VTE: transdermal
- NO conjugated estrogen
- NO ethinyl estradiol
Estradiaol oral vs sublingual
- Faster absorption after 1 hour
(But no data on physical effects or for the person)
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Effects
Desirable
UndesirableIrreversible
Variable
- Spontaneous erections, testicular volume, sperm production, erectile dysfunction
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Effects
Partly reversible
Variable
- Fat redistribution
- Scalp hair loss
Supporting sexuality and improving sexual function in transgender persons
Statements
We recommend health care professionals initiate and continue gender-affirming hormone therapy for eligible transgender and gender diverse people who require this treatment due to demonstrated improvement in psychosocial functioning and quality of life.
We recommend health care professionals maintain existing hormone therapy if the transgender and gender diverse individual's mental health deteriorates and assess the reason for the deterioration, unless contraindicated.
Monitoring
Every time: Same day, same time after taking hormones