Talk:Endocrine Society Guidelines

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Feminizing Effects in Transgender Females[1][2][3][edit]

Effect

Onset

Max

Change in body fat distribution

3–6 mo

2–3 y

Decrease in muscle mass and strength

3–6 mo

1–2 y

Softening of skin / decreased oiliness

3–6 mo

Unknown

Decreased sexual desire

1–3 mo

3–6 mo

Decreased spontaneous erections

1–3 mo

3–6 mo

Male sexual dysfunction

Variable

Variable

Breast growth

3–6 mo

2–3 y

Decreased testicular volume

3–6 mo

2–3 y

Decreased sperm production

Unknown

>3 y

Decreased terminal hair growth

6–12 mo

>3 y a

Scalp hair

Variable

b

Voice changes

None

c


a Complete removal of male sexual hair requires electrolysis or laser treatment or both.
b Familial scalp hair loss may occur if estrogens are stopped.
c Treatment by speech pathologists for voice training is most effective

Abbreviations: Unk, Unknown.

Feminizing Effects in Transgender Females[1][2][3][edit]

Effect

Onset

Max

Change in body fat distribution

3–6 mo

2–3 y

Decrease in muscle mass and strength

3–6 mo

1–2 y

Softening of skin / decreased oiliness

3–6 mo

Unknown

Decreased sexual desire

1–3 mo

3–6 mo

Decreased spontaneous erections

1–3 mo

3–6 mo

Male sexual dysfunction

Variable

Variable

Breast growth

3–6 mo

2–3 y

Decreased testicular volume

3–6 mo

2–3 y

Decreased sperm production

Unknown

>3 y

Decreased terminal hair growth

6–12 mo

>3 y a

Scalp hair

Variable

b

Voice changes

None

c


a Complete removal of male sexual hair requires electrolysis or laser treatment or both.
b Familial scalp hair loss may occur if estrogens are stopped.
c Treatment by speech pathologists for voice training is most effective

Abbreviations: Unk, Unknown.


Protocol Induction of Puberty[4][edit]

Induction of female puberty with oral 17b-estradiol, increasing the dose every 6 mo
5 μg/kg/d
10 μg/kg/d
15 μg/kg/d
20 μg/kg/d
Adult dose = 2–6 mg/d
In postpubertal transgender female adolescents, the dose of 17b-estradiol can be increased more rapidly:
1 mg/d for 6 mo
2 mg/d
Induction of female puberty with transdermal 17b-estradiol, increasing the dose every 6 mo (new patch is placed every 3.5 d)
6.25–12.5 μg/24 h (cut 25-μg patch into quarters, then halves)
25 μg/24 h
37.5 μg/24 h
Adult dose 5 50–200 μg/24 h

Protocol Induction of Puberty[4][edit]

Induction of female puberty with oral 17b-estradiol, increasing the dose every 6 mo
5 μg/kg/d
10 μg/kg/d
15 μg/kg/d
20 μg/kg/d
Adult dose = 2–6 mg/d
In postpubertal transgender female adolescents, the dose of 17b-estradiol can be increased more rapidly:
1 mg/d for 6 mo
2 mg/d
Induction of female puberty with transdermal 17b-estradiol, increasing the dose every 6 mo (new patch is placed every 3.5 d)
6.25–12.5 μg/24 h (cut 25-μg patch into quarters, then halves)
25 μg/24 h
37.5 μg/24 h
Adult dose 5 50–200 μg/24 h


Hormone Regimens in Transgender Persons[edit]

Transgender females a
Estrogen
Oral
Estradiol
2.0 – 6.0 mg/d
Transdermal
Estradiol transdermal patch
0.025 – 0.2 mg/d
(New patch placed every 3 – 5 d)
Parenteral
Estradiol valerate or cypionate
5 – 30 mg IM every 2 wk
2 – 10 mg IM every week
Anti-androgens
Spironolactone
100 – 300 mg/d
Cyproterone acetate b
25 – 50 mg/d
GnRH agonist
3.75 mg SQ (SC) monthly
11.25 mg SQ (SC) 3-monthly

Abbreviations: IM, intramuscularly; SQ, sequentially; SC, subcutaneously.

aEstrogens used with or without antiandrogens or GnRH agonist.
bNot available in the United States

Hormone Regimens in Transgender Persons[edit]

Transgender females a

Estrogen
Oral
Estradiol
2.0 – 6.0 mg/d
Transdermal
Estradiol transdermal patch

(New patch placed every 3 – 5 d)
0.025 – 0.2 mg/d
Parenteral
Estradiol valerate or cypionate
5 – 30 mg IM every 2 wk
2 – 10 mg IM every week
Anti-androgens
Spironolactone
100 – 300 mg/d
Cyproterone acetate b
25 – 50 mg/d
GnRH agonist
monthly
3.75 mg SQ (SC)
3-monthly
11.25 mg SQ (SC)

Abbreviations: IM, intramuscularly; SQ, sequentially; SC, subcutaneously.



aEstrogens used with or without antiandrogens or GnRH agonist.

bNot available in the United States

Transgender female: estrogen[edit]

Very high risk of adverse outcomes
  • Thromboembolic disease
Moderate risk of adverse outcomes
  • Macroprolactinoma
  • Breast cancer
  • Coronary artery disease
  • Cerebrovascular disease
  • Cholelithiasis
  • Hypertriglyceridemia

Transgender female: estrogen[edit]

Very high risk of adverse outcomes
  • Thromboembolic disease
Moderate risk of adverse outcomes
  • Macroprolactinoma
  • Breast cancer
  • Coronary artery disease
  • Cerebrovascular disease
  • Cholelithiasis
  • Hypertriglyceridemia


Baseline and Follow-Up Protocol During Suppression of Puberty[4][edit]

NOTE:"Measurements of gonadotropin and sex steroid levels give precise information about gonadal axis suppression, although there is insufficient evidence for any specific short-term monitoring scheme in children treated with GnRH analogs [5]. If the gonadal axis is not completely suppressed—as evidenced by (for example) menses, erections, or progressive hair growth—the interval of GnRH analog treatment can be shortened or the dose increased. During treatment, adolescents should be monitored for negative effects of delaying puberty, including a halted growth spurt and impaired bone mineral accretion. The following table illustrates a suggested clinical protocol."[4] [footnote 1]

Every 3–6 mo
Anthropometry: height, weight, sitting height, blood pressure, Tanner stages
Every 6–12 mo
Laboratory: LH, FSH, E2/T, 25OH vitamin D
Every 1–2 y
Bone density using DXA
Bone age on X-ray of the left hand (if clinically indicated)


Abbreviations: DXA, dual-energy X-ray absorptiometry; E2, estradiol; FSH, follicle stimulating hormone; LH, luteinizing hormone; T, testosterone;


Baseline and Follow-up Protocol During Induction of Puberty[4][edit]

Every 3–6 mo
  • Anthropometry: height, weight, sitting height, blood pressure, Tanner stages
Every 6–12 mo
  • In transgender males: hemoglobin/hematocrit, lipids, testosterone, 25OH vitamin D
  • In transgender females: prolactin, estradiol, 25OH vitamin D
Every 1–2 y
  • BMD using DXA
  • Bone age on X-ray of the left hand (if clinically indicated)

BMD should be monitored into adulthood (until the age of 25–30 y or until peak bone mass has been reached). For recommendations on monitoring once pubertal induction has been completed, see Tables 14 and 15.

Abbreviation: DXA, dual-energy X-ray absorptiometry


Footnotes[edit]

  1. (Pg 15) Measurements of gonadotropin and sex steroid levels give precise information about gonadal axis suppression, although there is insufficient evidence for any specific short-term monitoring scheme in children treated with GnRH analogs (88). If the gonadal axis is not completely suppressed—as evidenced by (for example) menses, erections, or progressive hair growth—the interval of GnRH analog treatment can be shortened or the dose increased. During treatment, adolescents should be monitored for negative effects of delaying puberty, including a halted growth spurt and impaired bone mineral accretion. The following table illustrates a suggested clinical protocol.

References[edit]

  1. 1.0 1.1 Price TM, Blauer KL, Hansen M, Stanczyk F, Lobo R, Bates GW. Single-dose pharmacokinetics of sublingual versus oral administration of micronized 17b-estradiol. Obstet Gynecol. 1997;89(3): 340–345.
  2. 2.0 2.1 Asscheman H, Gooren LJ, Assies J, Smits JP, de Slegte R. Prolactin levels and pituitary enlargement in hormone-treated male-to-female transsexuals. Clin Endocrinol (Oxf). 1988;28(6):583–588.
  3. 3.0 3.1 Gooren LJ, Harmsen-Louman W, van Kessel H. Follow-up of prolactin levels in long-term oestrogen-treated male-to-female transsexuals with regard to prolactinoma induction. Clin Endocrinol (Oxf). 1985;22(2):201–207.
  4. 4.0 4.1 4.2 4.3 4.4 Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ 3rd, Spack NP, Tangpricha V, Montori VM; Endocrine Society. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–3154.
  5. Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR, Antoniazzi F, Berenbaum S, Bourguignon JP, Chrousos GP, Coste J, Deal S, de Vries L, Foster C, Heger S, Holland J, Jahnukainen K, Juul A, Kaplowitz P, Lahlou N, Lee MM, Lee P, Merke DP, Neely EK, Oostdijk W, Phillip M, Rosenfield RL, Shulman D, Styne D, Tauber M, Wit JM; ESPE-LWPES GnRH Analogs Consensus Conference Group. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123(4):e752–e762.