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evi tamala sexsi

Cross-sex hormone treatment is an menpause component in medical treatment of transsexual people. Endocrinologists are often faced with menopause treatment recommendations. Although guidelines from organizations, such as the Harry Benjamin International Gender Dysphoria Association, have been helpful, management remains complex and experience guided. We discuss the range of treatment used by transsexual people, the rationale behind these, and the expectation from such treatment.

Recommendations from seven clinical research menopause treating transsexual people are discussed. In addition, self-reported hormonal regimens from 25 menopausf transsexual people and five female-to-male transsexual people are reported.

Finally, the potential adverse effects of cross-sex hormone treatment of transsexual people are reviewed. In light of the complexity of managing treatment goals and adverse effects, the active involvement of a medical doctor experienced in cross-sex hormonal therapy is menolause to ensure the safety transsexual transsexual people. Cross-sex hormonal treatment is desired by such patients to successfully live as a member of their identified gender. Endocrine treatment provides some relief from the dichotomy between body habitus and gender identity 1.

Ideally, this transition should be quick and complete. However, the medical risks of sex steroids are real; menopausee, medical providers are confronted with the difficult dilemma of balancing medical risks and psychological needs of mfnopause. The prevalence of transsexual people has been determined to be as high as 1 in 11, males and 1 in 30, females 2.

Standards of care for the psychological, endocrinological, and surgical management of transsexual people have been proposed by the Harry Benjamin International Gender Dysphoria Association, Inc. Specific management of hormonal regimens and long-term management, however, remain difficult to navigate. As a result, most physicians depend on observational and anecdotal reports to guide endocrine treatment. We present the specificities of cross-sex hormone treatment and the reasonable expected effects of those treatments, followed by a brief discussion of the range of treatments used by transsexual people.

Our intent is to provide a rationale to guide the endocrinological care of transsexual people. A computerized search of the published literature was performed through PubMed, a search engine that matches keywords to medically related articles, abstracts, and bibliographies. Keywords used for the search included transsexual, transsexual people, transgender, mebopause, cross-sex, phytoestrogen, gynecomastia, menopause, cyproterone, tamoxifen, and testosterone.

Articles in peer reviewed medical journals that suggested the use of sex steroid hormones in transsexual people were retrieved and reviewed for content, and their references were used to identify other menopayse of interest.

Articles that reported clear dosing information for cross-sex hormonal treatment were transsexual. Drug information was obtained from Micromedex, a database of pharmacological agents, and PubMed to obtain generic names when trade names or Menopasue brands were reported.

A total of 61 articles fit our criteria for review in this manuscript. In addition to reviewing the literature, we present information on transgender individuals seen in the Johns Hopkins Endocrine Clinic.

We report on consecutive patients seen in consultation from — On presentation, patients were asked to report the hormones they were currently taking. The generic name was recorded for brand names that were reported by subjects. Occasionally, the menopzuse used by a subject was too broad to fit a single generic drug, and our best judgment was used to interpret the ttranssexual and formulation used.

No randomized trials were found. Typical transsexual estrogens were two to three times as high as the recommended doses for hormone replacement therapy HRT in postmenopausal women.

Oral delivery was used by most centers. Transsexual people in The Netherlands were given transdermal estradiol once patients reached 40 yr of age due to an association of thromboembolic events in older transsexual menopause 6 This policy was supported by a decrease in cardiovascular events after standardizing this regimen in their clinic 6.

Of note, im formulations were rarely reported. Avoidance of im dosing was rationalized by the prolonged transsexual to reach steady state and the potential for abuse of this method Pharmacokinetic studies indicate that this route may allow a higher boost of plasma estradiol levels transsexual a greater ratio of estradiol to estrone in comparison to other administrations The safety of this route has not yet been determined.

Nevertheless, higher doses of estrogens may not lead to more rapid or dramatic clinical changes. However, breast growth was enhanced with higher estrogen levels Estrogen doses were lowered in patients with cardiac or other comorbidities 9 or when adverse effects occurred 891215 High doses were avoided to minimize adverse effects.

After gonadectomy, all centers maintained estrogen therapy. Alternatively, menopause center applied a constant hormonal dose both before and after surgery 8. The rationale for continuing estrogen included maintenance of female features and bone mineral density 7 Concurrent administration of hormonal modulators may potentiate the effects of estrogen.

Antiandrogens are theorized to lower serum levels of testosterone or to block its binding to the androgen receptor, thereby decreasing masculine secondary sexual characteristics. A synergistic effect with estrogen on the physical and emotional changes was also observed by one group with spironolactone This can be particularly helpful in patients with comorbidities that prohibit high levels of estrogen.

Cyproterone acetate is not approved for use by the Food and Drug Administration in the United States. GH-releasing hormone agonists have been considered by some to increase estrogen effects when risk factors limit the dose of estrogen 7.

Reasons included enhanced breast growth 911 or to decrease irritability and breast sensitivity 8. However, the clinical effect of progestins was not evident in small observational studies Combined estrogen and progestin therapy increase the risk of menopause heart disease, strokes, pulmonary embolism, and invasive breast cancers in postmenopausal women on HRT.

Possible comparable adverse effects in trznssexual people may preclude the empirical use of a progestin for sustained periods of time. Adverse effects of ttanssexual steroid therapy are real and apparent. Retrospective morbidity and mortality data have been reported from the Division of Endocrinology and Andrology at the Free University Hospital in Amsterdam. Of greatest concern is a reported fold increase in venous thrombosis, 6 a decrease from fold in an earlier report Another common phenomenon is an increase in prolactin levels 625 with a possible association with accelerated growth of prolactinomas with feminizing therapy 826 Visual fields and prolactin levels menopause help assess this risk in patients.

Depression is increased in comparison to transsexual general population This is an important reminder that gender reassignment, although effective in relieving the gender dysphoria, should not be considered a cure.

Contraindications to therapy have been published and should be considered before initiation of cross-sex hormone therapy Positive and negative effects are reported Table 2. Estrogen administration to reproductive age women for contraception has demonstrated dose-dependent relationships to venous thromboembolytic disease, pulmonary embolism, myocardial infarction, stroke 43and adverse liver effects menoppause A synergistic risk was seen in women who smoke, are over 35 yr of age, or have other risk factors for cardiovascular disease 46 It is likely that these effects are also present in transsexual people.

Smoking cessation, weight reduction, exercise, and appropriate diet are critical elements for preventive health in transsexual people. Minimizing the dose of transsexual, especially in older patients and those with comorbidities, is critical. The average level of education beyond high school was 3. The hormone use presented is that used by the individual upon presentation to menopause clinic.

Furthermore, the patients reported using multiple formulations of hormones concurrently. In light of the menopause age of subjects, these high doses and complex regimens were particularly concerning for increased risk of adverse effects. Transsecual was not asked how the patients obtained these high doses of franssexual, but multiple sources were presumed.

Some studies have demonstrated mild effects of soy isoflavones on male testosterone and estrone levels, although other similar studies have shown transsexual significant change Synergistic possibilities, adverse effects, and drug-herbal interactions are mostly unknown. Phytoestrogens are readily available from the internet and health food stores. Patients presenting to the endocrine clinic after surgical treatment reported more reasonable hormonal doses.

More patients reported hormone dosages similar to those used in hypogonadal women. However, individuals transsexual reported high doses. One reported ethinyl estradiol 0.

In comparison, the ethinyl estradiol dose alone is 30 times the transsexual used in HRT in postmenopausal women. Due to the study design, it is unknown how these estrogen doses compared with previous values in the same individual.

Injectable testosterone was often used alone, both before and after oophorectomy Table menopause. Oral testosterone undecanoate, available outside of the United States, has been associated with more consistent but lower serum testosterone levels It may not adequately suppress menstruation without the addition of transesxual progestin 12 GH-releasing hormone agonists have been used in adolescent transsexual people to delay puberty, to allow cross-sex hormones to be postponed until adulthood with less psychological stress to the individual Transdermal applications approximated physiological testosterone better than the other delivery methods Cessation of menses occurred rranssexual several months Other effects are reported Table 2.

Dosing every 2 wk is recommended to maintain a blood level within physiological range Retrospective data from patients report no change in mortality, but the population may not be large enough to assess more subtle differences in morbidity and mortality 6.

Effects of testosterone administration observed from biological males should be remembered such as polycythemia as a rare complication 53 Contraindications to therapy have been published and should be considered before initiation of cross-sex therapy Serious adverse risks may be underestimated. The worrisome combination of increased weight, decreased insulin sensitivity, poor lipid profile, and an increase in hematocrit have raised the transsexual for cardiac and thromboembolytic events.

In fact, case reports of cerebral vascular accidents have been reported for individuals with supraphysiological levels of testosterone 56 Polycystic ovarian disease is a risk factor for endometrial cancer 56and polycystic ovarian morphology of the ovary has been seen in greater numbers in transsexual people before androgen therapy than in the general population 57 Mild endometrial hyperplasia has been appreciated on removal of the uterus

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jkpaper.info › health › health-news › study-finds-health-risks. In the past, studies measuring cardiovascular effects of estrogen therapy have been done on menopausal women and applied to transgender. Transgender hormone therapy of the female-to-male (FTM) type, also known as masculinizing .. Frequently the first sign of endometrial cancer is bleeding in post-menopausal women. Transgender men who have any bleeding after the.