Medical Transition for Gender Diverse Patients

Abstract

Purpose of Review

The purpose of this review is to provide an up-to-date overview of gender-affirming hormone therapy, including the various hormone regimens available, the efficacy and potential risks of these treatments, and considerations for surveillance and long-term care.

Recent Findings

Recent studies reaffirm that hormone therapy has positive physical and psychological effects for many transgender individuals. The overall risks of treatment are low. Transgender women may have an increased risk of venous thromboembolism and breast cancer based on recent cohort studies, but these findings have yet to be confirmed with randomized controlled trials. Important long-term considerations include metabolic, cardiovascular, and skeletal health.

Summary

High-quality, long-term studies on the effectiveness and safety of various gender-affirming hormone treatment regimens are lacking, but the currently available evidence suggests that it is overall safe and effective with appropriate oversight.

This is a preview of subscription content, log in to check access.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, trans-gender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13(4).

  2. 2.

    Saraswat A, Weinand JD, Safer JD. Evidence supporting the biologic nature of gender identity. Endocr Pract. 2015;21(2):199–204.

    PubMed  Google Scholar 

  3. 3.

    Rosenthal SM. Approach to the patient: transgender youth: endocrine considerations. J Clin Endocrinol Metab. 2014;99(12):4379–89.

    CAS  PubMed  Google Scholar 

  4. 4.

    Leinung M, Urizar M, Patel N, Sood S. Endocrine treatment of transsexual persons: extensive personal experience. Endocr Pract. 2013;19(4):644–50.

    PubMed  Google Scholar 

  5. 5.

    •• Safer JD, Tangpricha V. Care of the transgender patient. Ann Intern Med. 2019;171(1):ITC1–14 This paper provides a thorough review of primary care guidelines for transgender patients.

    PubMed  Google Scholar 

  6. 6.

    Cavanaugh T, Hopwood R, Lambert C. Informed consent in the medical care of transgender and gender-nonconforming patients. AMA J Ethics. 2016;18(11):1147–55.

    PubMed  Google Scholar 

  7. 7.

    •• Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869–903 This is a comprehensive overview of gender-affirming hormone therapy and provides recommendations from the Endocrine Society.

    PubMed  PubMed Central  Google Scholar 

  8. 8.

    Pelusi C, Costantino A, Martelli V, Lambertini M, Bazzocchi A, Ponti F, et al. Effects of three different testosterone formulations in female-to-male transsexual persons. J Sex Med. 2014;11(12):3002–11.

    PubMed  Google Scholar 

  9. 9.

    Meriggiola MC, Gava G. Endocrine care of transpeople part I. A review of cross-sex hormonal treatments, outcomes and adverse effects in transmen. Clin Endocrinol. 2015;83(5):597–606.

    CAS  Google Scholar 

  10. 10.

    Jockenhövel F. Testosterone therapy - what, when and to whom? Aging Male. 2004;7(4):319–24.

    PubMed  Google Scholar 

  11. 11.

    Seftel A. Testosterone replacement therapy for male hypogonadism: part III. Pharmacologic and clinical profiles, monitoring, safety issues, and potential future agents. Int J Impot Res. 2007;19(1):2–24.

    CAS  PubMed  Google Scholar 

  12. 12.

    Mueller A, Kiesewetter F, Binder H, Beckmann MW, Dittrich R. Long-term administration of testosterone undecanoate every 3 months for testosterone supplementation in female-to-male transsexuals. J Clin Endocrinol Metab. 2007;92(9):3470–5.

    CAS  PubMed  Google Scholar 

  13. 13.

    Asscheman H, Gooren LJG, Eklund PLE. Mortality and morbidity in transsexual patients with cross-gender hormone treatment. Metabolism. 1989;38(9):869–73.

    CAS  PubMed  Google Scholar 

  14. 14.

    McFarland J, Craig W, Clarke NJ, Spratt DI. Serum testosterone concentrations remain stable between injections in patients receiving subcutaneous testosterone. J Endocr Soc. 2017;1(8):1095–103.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Spratt DI, Stewart II, Savage C, Craig W, Spack NP, Chandler DW, et al. Subcutaneous injection of testosterone is an effective and preferred alternative to intramuscular injection: demonstration in female-to-male transgender patients. J Clin Endocrinol Metab. 2017;102(7):2349–55.

    PubMed  Google Scholar 

  16. 16.

    Moravek MB. Gender-affirming hormone therapy for transgender men. Clin Obstet Gynecol. 2018;61(4):687–704.

    PubMed  Google Scholar 

  17. 17.

    Gooren LJ. Care of transsexual persons. N Engl J Med. 2011;364(13):1251–7.

    CAS  PubMed  Google Scholar 

  18. 18.

    Marks DH, Hagigeorges D, Manatis-Lornell AJ, Dommasch E, Senna MM. Hair loss among transgender and gender-nonbinary patients: a cross-sectional study. Br J Dermatol. 2019;181(5):1082–3.

    CAS  PubMed  Google Scholar 

  19. 19.

    Randolph JF. Gender-affirming hormone therapy for transgender females. Clin Obstet Gynecol. 2018;61(4):705–21.

    PubMed  Google Scholar 

  20. 20.

    Prior JC, Vigna YM, Watson D. Spironolactone with physiological female steroids for presurgical therapy of male-to-female transsexualism. Arch Sex Behav. 1989;18(1):49–57.

    CAS  PubMed  Google Scholar 

  21. 21.

    Kolvenbag GJCM, Blackledge GRP. Worldwide activity and safety of bicalutamide: a summary review. Urology. 1996;47(1 SUPPL. 1):70–9.

    CAS  PubMed  Google Scholar 

  22. 22.

    Oriel KA. Medical care of transsexual patients. J Gay Lesbian Med Assoc. 2000;4(4):185–94.

    Google Scholar 

  23. 23.

    Wierckx K, Gooren L, T’Sjoen G. Clinical review: breast development in trans women receiving cross-sex hormones. J Sex Med. 2014;11(5):1240–7.

    PubMed  Google Scholar 

  24. 24.

    Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the women’s health initiative randomized controlled trial. J Am Med Assoc. 2002;288(3):321–33.

    CAS  Google Scholar 

  25. 25.

    Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364.

  26. 26.

    Turner L, Ly LP, Desai R, Singh GKS, Handelsman TD, Savkovic S, et al. Pharmacokinetics and acceptability of subcutaneous injection of testosterone undecanoate. J Endocr Soc. 2019;3(8):1531–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Irwig MS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol. 2017;5(4):301–11.

    CAS  PubMed  Google Scholar 

  28. 28.

    Gooren LJG, Giltay EJ. Review of studies of androgen treatment of female-to-male transsexuals: effects and risks of administration of androgens to females. J Sex Med. 2008;5(4):765–76.

    CAS  PubMed  Google Scholar 

  29. 29.

    Cosyns M, Van Borsel J, Wierckx K, Dedecker D, Van De Peer F, Daelman T, et al. Voice in female-to-male transsexual persons after long-term androgen therapy. In: Laryngoscope. John Wiley and Sons Inc; 2014. p. 1409–1414.

  30. 30.

    Cler GJ, McKenna VS, Dahl KL, Stepp CE. Longitudinal case study of transgender voice changes under testosterone hormone therapy. J Voice. 2019;

  31. 31.

    Wierckx K, Van Caenegem E, Schreiner T, Haraldsen I, Fisher A, Toye K, et al. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence. J Sex Med. 2014;11(8):1999–2011.

    CAS  PubMed  Google Scholar 

  32. 32.

    Gooren LJ, Giltay EJ, Bunck MC. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab. 2008;93(1):19–25.

    CAS  PubMed  Google Scholar 

  33. 33.

    Wiik A, Lundberg TR, Rullman E, Andersson DP, Holmberg M, Mandić M, et al. Muscle strength, size, and composition following 12 months of gender-affirming treatment in transgender individuals. J Clin Endocrinol Metab. 2020;105(3).

  34. 34.

    Meyer WJ, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA. Physical and hormonal evaluation of transsexual patients: a longitudinal study. Arch Sex Behav. 1986;15(2):121–38.

    PubMed  Google Scholar 

  35. 35.

    Deutsch MB, Bhakri V, Kubicek K. Effects of cross-sex hormone treatment on transgender women and men. Obstet Gynecol. 2015;125(3):605–10.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Shadid S, Abosi-Appeadu K, De Maertelaere AS, Defreyne J, Veldeman L, Holst JJ, et al. Effects of gender-affirming hormone therapy on insulin sensitivity and incretin responses in transgender people. Diabetes Care. 2020;43(2):411–7.

    PubMed  Google Scholar 

  37. 37.

    Irwig MS. Safety concerns regarding 5α reductase inhibitors for the treatment of androgenetic alopecia. Curr Opin Endocrinol Diabetes Obes. 2015;22(3):248–53.

    CAS  PubMed  Google Scholar 

  38. 38.

    Center of Excellence for Transgender Health. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. Univ California, San Fr. 2016;

  39. 39.

    American College of Obstetricians and Gynecologists. Practice Bulletin No. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol 2012;120(1):197–206.

  40. 40.

    Ristori J, Cocchetti C, Castellini G, Pierdominici M, Cipriani A, Testi D, et al. Hormonal treatment effect on sexual distress in transgender persons: 2-year follow-up data. J Sex Med. 2020;17(1):142–51.

    CAS  PubMed  Google Scholar 

  41. 41.

    Defreyne J, Elaut E, Kreukels B, Fisher AD, Castellini G, Staphorsius A, et al. Sexual desire changes in transgender individuals upon initiation of hormone treatment: results from the longitudinal European Network for the Investigation of Gender Incongruence. J Sex Med. 2020;17(4):812–25.

    CAS  PubMed  Google Scholar 

  42. 42.

    Wierckx K, Mueller S, Weyers S, Van Caenegem E, Roef G, Heylens G, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med. 2012;9(10):2641–51.

    CAS  PubMed  Google Scholar 

  43. 43.

    Nolan BJ, Leemaqz SY, Ooi O, Cundill P, Silberstein N, Locke P, et al. Prevalence of polycythaemia with different formulations of testosterone therapy in transmasculine individuals. Intern Med J. 2020.

  44. 44.

    Byrnes JR, Wolberg AS. Red blood cells in thrombosis. Blood. 2017;130(16):1795–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Weinand JD, Safer JD. Hormone therapy in transgender adults is safe with provider supervision; a review of hormone therapy sequelae for transgender individuals. J Clin Transl Endocrinol. 2015;2(2):55–60.

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Elamin MB, Garcia MZ, Murad MH, Erwin PJ, Montori VM. Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses. Clin Endocrinol. 2010;72(1):1–10.

    CAS  Google Scholar 

  47. 47.

    Asscheman H, Giltay EJ, Megens JAJ, De Ronde W, Van Trotsenburg MAA, Gooren LJG. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol. 2011;164(4):635–42.

    CAS  PubMed  Google Scholar 

  48. 48.

    Streed CG, Harfouch O, Marvel F, Blumenthal RS, Martin SS, Mukherjee M. Cardiovascular disease among transgender adults receiving hormone therapy: a narrative review. Ann Intern Med. 2017;167(4):256–67.

    PubMed  Google Scholar 

  49. 49.

    Cancer risk in the transgender community. Lancet Oncol. 2015;16(9):999.

  50. 50.

    Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Heal. 2016;4(9):e609–16.

    Google Scholar 

  51. 51.

    Nash R, Ward KC, Jemal A, Sandberg DE, Tangpricha V, Goodman M. Frequency and distribution of primary site among gender minority cancer patients: an analysis of U.S. national surveillance data. Cancer Epidemiol. 2018;54:1–6.

    PubMed  PubMed Central  Google Scholar 

  52. 52.

    Buchting FO, Emory KT, Scout, Kim Y, Fagan P, Vera LE, et al. Transgender use of cigarettes, cigars, and e-cigarettes in a national study. Am J Prev Med. 2017;53(1):e1–7.

    PubMed  PubMed Central  Google Scholar 

  53. 53.

    Silverberg MJ, Nash R, Becerra-Culqui TA, Cromwell L, Getahun D, Hunkeler E, et al. Cohort study of cancer risk among insured transgender people. Ann Epidemiol. 2017;27(8):499–501.

    PubMed  Google Scholar 

  54. 54.

    Gooren LJ, van Trotsenburg MAAA, Giltay EJ, van Diest PJ. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med. 2013;10(12):3129–34.

    PubMed  PubMed Central  Google Scholar 

  55. 55.

    • De Blok CJM, Wiepjes CM, Nota NM, Van Engelen K, Adank MA, Dreijerink KMA, et al. Breast cancer risk in transgender people receiving hormone treatment: Nationwide cohort study in the Netherlands. BMJ. 2019;365. This study showed that breast cancer risk in transgender men is higher than in cisgender men but lower than cisgender women. In transgender women, the risk of breast cancer was significantly higher than in cisgender men.

  56. 56.

    Feng J, Li L, Zhang N, Liu J, Zhang L, Gao H, et al. Androgen and AR contribute to breast cancer development and metastasis: an insight of mechanisms. Oncogene. 2017;36(20):2775–90.

    CAS  PubMed  Google Scholar 

  57. 57.

    Fundytus A, Saad N, Logie N, Roldan UG. Breast cancer in transgender female-to-male individuals: a case report of androgen receptor-positive breast cancer. Breast J. 2019.

  58. 58.

    Lips P, van Kesteren PJM, Asscheman H, Gooren LJG. The effect of androgen treatment on bone metabolism in female-to-male transsexuals. J Bone Miner Res. 2009;11(11):1769–73.

    Google Scholar 

  59. 59.

    Wiepjes CM, de Jongh RT, de Blok CJM, Vlot MC, Lips P, Twisk JWR, et al. Bone safety during the first ten years of gender-affirming hormonal treatment in transwomen and transmen. J Bone Miner Res. 2019;34(3):447–54.

    CAS  PubMed  Google Scholar 

  60. 60.

    • Wiepjes CM, de Blok CJM, Staphorsius AS, Nota NM, Vlot MC, de Jongh RT, et al. Fracture risk in trans women and trans men using long-term gender-affirming hormonal treatment: a nationwide cohort study. J Bone Miner Res. 2020;35(1):64–70 This is the first study looking at fracture risk in a large cohort of transgender men and women on long-term hormone therapy.

    PubMed  Google Scholar 

  61. 61.

    Dobrolińska M, van der Tuuk K, Vink P, van den Berg M, Schuringa A, Monroy-Gonzalez AG, et al. Bone mineral density in transgender individuals after gonadectomy and long-term gender-affirming hormonal treatment. J Sex Med. 2019;16(9):1469–77.

    PubMed  Google Scholar 

  62. 62.

    Park S, Cheng CP, Lim LT, Gerber D. Secondary intracranial hypertension from testosterone therapy in a transgender patient. Semin Ophthalmol. 2014;29(3):156–8.

    PubMed  Google Scholar 

  63. 63.

    Nguyen H V., Gilbert AL, Fortin E, Vodopivec I, Torun N, Chwalisz BK, et al. Elevated intracranial pressure associated with exogenous hormonal therapy used for gender affirmation. J Neuro-Ophthalmology. 2020;1.

  64. 64.

    Mowl AD, Grogg JA, Klein J. Secondary pseudotumour cerebri in a patient undergoing sexual reassignment therapy. Clin Exp Optom. 2009;92(5):449–53.

    PubMed  Google Scholar 

  65. 65.

    Buchanan I, Hansen K, Bedolla J. Idiopathic intracranial hypertension in a transgender male on hormone therapy. Arch Emerg Med Crit Care. 2017;2(1).

  66. 66.

    Stark B, Hughto JMW, Charlton BM, Deutsch MB, Potter J, Reisner SL. The contraceptive and reproductive history and planning goals of trans-masculine adults: a mixed-methods study. Contraception. 2019;100(6):468–73.

    PubMed  Google Scholar 

  67. 67.

    Riggs DW, Bartholomaeus C. Fertility preservation decision making amongst Australian transgender and non-binary adults. Reprod Health. 2018;15(1):181.

    PubMed  PubMed Central  Google Scholar 

  68. 68.

    Auer MK, Fuss J, Nieder TO, Briken P, Biedermann SV, Stalla GK, et al. Desire to have children among transgender people in Germany: a cross-sectional multi-center study. J Sex Med. 2018;15(5):757–67.

    Google Scholar 

  69. 69.

    Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. 2014;124(6):1120–7.

    CAS  Google Scholar 

  70. 70.

    Obedin-Maliver J, Makadon HJ. Transgender men and pregnancy. Obstet Med. 2016;9(1):4–8.

    Google Scholar 

  71. 71.

    Moravek MB, Kinnear HM, George J, Batchelor J, Shikanov A, Padmanabhan V, et al. Impact of exogenous testosterone on reproduction in transgender men. Endocrinology. 2020;161(3).

  72. 72.

    Taub RL, Adriane Ellis S, Neal-Perry G, Margaret AS, Prager SW, Micks EA. The effect of testosterone on ovulatory function in transmasculine individuals. Am J Obstet Gynecol. 2020.

  73. 73.

    Moravek MB. Fertility preservation options for transgender and gender-nonconforming individuals. Curr Opin Obstet Gynecol. 2019;31(3):170–6.

    Google Scholar 

  74. 74.

    Dutra E, Lee J, Torbati T, Garcia M, Merz CNB, Shufelt C. Cardiovascular implications of gender-affirming hormone treatment in the transgender population. Maturitas. 2019;129:45–9.

    CAS  PubMed  Google Scholar 

  75. 75.

    Jain J, Kwan D, Forcier M. Medroxyprogesterone acetate in gender-affirming therapy for transwomen: results from a retrospective study. J Clin Endocrinol Metab. 2019;104(11):5148–56.

    PubMed  Google Scholar 

  76. 76.

    Stevenson MO, Wixon N, Safer JD. Scalp hair regrowth in hormone-treated transgender women. Transgender Heal. 2016;1(1):202–4.

    Google Scholar 

  77. 77.

    Nota NM, Wiepjes CM, De Blok CJM, Gooren LJG, Kreukels BPC, Den Heijer M. Occurrence of acute cardiovascular events in transgender individuals receiving hormone therapy. Circulation. 2019;139(11):1461–2.

    PubMed  Google Scholar 

  78. 78.

    Getahun D, Nash R, Flanders WD, Baird TC, Becerra-Culqui TA, Cromwell L, et al. Cross-sex hormones and acute cardiovascular events in transgender persons: a cohort study. Ann Intern Med. 2018;169(4):205–13.

    PubMed  PubMed Central  Google Scholar 

  79. 79.

    The Coronary Drug Project. Initial findings leading to modifications of its research protocol. JAMA. 1970;214(7):1303–13.

    Google Scholar 

  80. 80.

    Alzahrani T, Nguyen T, Ryan A, Dwairy A, McCaffrey J, Yunus R, et al. Cardiovascular disease risk factors and myocardial infarction in the transgender population. Circ Cardiovasc Qual Outcomes. 2019;12(4).

  81. 81.

    Maraka S, Ospina NS, Rodriguez-Gutierrez R, Davidge-Pitts CJ, Nippoldt TB, Prokop LJ, et al. Sex steroids and cardiovascular outcomes in transgender individuals: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2017;102(11):3914–23.

    PubMed  Google Scholar 

  82. 82.

    Spanos C, Bretherton I, Zajac JD, Cheung AS. Effects of gender-affirming hormone therapy on insulin resistance and body composition in transgender individuals: a systematic review. World J Diabetes. 2020;11(3):66–77.

    PubMed  PubMed Central  Google Scholar 

  83. 83.

    Nota NM, Dekker MJHJ, Klaver M, Wiepjes CM, van Trotsenburg MA, Heijboer AC, et al. Prolactin levels during short- and long-term cross-sex hormone treatment: an observational study in transgender persons. Andrologia. 2017;49(6):e12666.

    Google Scholar 

  84. 84.

    Bunck MC, Debono M, Giltay EJ, Verheijen AT, Diamant M, Gooren LJ. Autonomous prolactin secretion in two male-to-female transgender patients using conventional oestrogen dosages. BMJ Case Rep. 2009;2009.

  85. 85.

    Cunha FS, Domenice S, Câmara VL, Sircili MHP, Gooren LJG, Mendonça BB, et al. Diagnosis of prolactinoma in two male-to-female transsexual subjects following high-dose cross-sex hormone therapy. Andrologia. 2015;47(6):680–4.

    CAS  PubMed  Google Scholar 

  86. 86.

    Kovacs K, Stefaneanu L, Ezzat S, Smyth HS. Prolactin-producing pituitary adenoma in a male-to-female transsexual patient with protracted estrogen administration: a morphologic study. Arch Pathol Lab Med. 1994;118(5):562–5.

    CAS  PubMed  Google Scholar 

  87. 87.

    Asscheman H, Gooren LJG, Assies J, Smits JPH, De Slegte R. Prolactin levels and pituitary enlargement in hormone-treated male-to-female transsexuals. Clin Endocrinol. 1988;28(6):583–8.

    CAS  Google Scholar 

  88. 88.

    Serri O, Noiseux D, Robert F, Hardy J. Lactotroph hyperplasia in an estrogen treated male-to-female transsexual patient. J Clin Endocrinol Metab. 1996;81(9):3177–9.

    CAS  PubMed  Google Scholar 

  89. 89.

    Bisson JR, Chan KJ, Safer JD. Prolactin levels do not rise among transgender women treated with estradiol and spironolactone. Endocr Pract. 2018;24(7):646–51.

    PubMed  Google Scholar 

  90. 90.

    Stevenson MO, Tangpricha V. Osteoporosis and bone health in transgender persons. Endocrinol Metab Clin N Am. 2019;48(2):421–7.

    Google Scholar 

  91. 91.

    Van Caenegem E, Taes Y, Wierckx K, Vandewalle S, Toye K, Kaufman JM, et al. Low bone mass is prevalent in male-to-female transsexual persons before the start of cross-sex hormonal therapy and gonadectomy. Bone. 2013;54(1):92–7.

    PubMed  Google Scholar 

  92. 92.

    Wiepjes CM, Vlot MC, Klaver M, Nota NM, de Blok CJ, de Jongh RT, et al. Bone mineral density increases in trans persons after 1 year of hormonal treatment: a multicenter prospective observational study. J Bone Miner Res. 2017;32(6):1252–60.

    CAS  PubMed  Google Scholar 

  93. 93.

    Van Caenegem E, T’sjoen G. Bone in trans persons. Curr Opin Endocrinol Diabetes Obes. 2015;22(6):459–66.

    PubMed  Google Scholar 

  94. 94.

    Boehmer U, Gereige J, Winter M, Ozonoff A, Scout N. Transgender individuals’ cancer survivorship: results of a cross-sectional study. Cancer. 2020;126:2829–36.

    PubMed  Google Scholar 

  95. 95.

    Grynberg M, Fanchin R, Dubost G, Colau JC, Brémont-Weil C, Frydman R, et al. Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population. Reprod BioMed Online. 2010;20(4):553–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  96. 96.

    Banks E, Beral V, Bull D, Reeves G, Austoker J, English R, et al. Breast cancer and hormone-replacement therapy in the million women study. Lancet. 2003;362(9382):419–27.

    Google Scholar 

  97. 97.

    Colditz GA, Hankinson SE, Hunter DJ, Willett WC, Manson JE, Stampfer MJ, et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med. 1995;332(24):1589–93.

    CAS  PubMed  Google Scholar 

  98. 98.

    Brown GR, Jones KT. Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat. 2015;149(1):191–8.

    PubMed  PubMed Central  Google Scholar 

  99. 99.

    Bremner WJ. Contraception for men: a breakthrough new approach. Cell. 2012;150(4):667–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  100. 100.

    Matoso A, Khandakar B, Yuan S, Wu T, Wang LJ, Lombardo KA, et al. Spectrum of findings in orchiectomy specimens of persons undergoing gender confirmation surgery. Hum Pathol. 2018;76:91–9.

    Google Scholar 

  101. 101.

    Kent MA, Winoker JS, Grotas AB. Effects of feminizing hormones on sperm production and malignant changes: microscopic examination of post orchiectomy specimens in transwomen. Urology. 2018;121:93–6.

    PubMed  Google Scholar 

  102. 102.

    Adeleye AJ, Reid G, Kao CN, Mok-Lin E, Smith JF. Semen parameters among transgender women with a history of hormonal treatment. Urology. 2019;124:136–41.

    PubMed  PubMed Central  Google Scholar 

  103. 103.

    Kailas M, Lu HMS, Rothman EF, Safer JD. Prevalence and types of gender-affirming surgery among a sample of transgender endocrinology patients prior to state expansion of insurance coverage. Endocr Pract. 2017;23(7):780–6.

    PubMed  Google Scholar 

  104. 104.

    Boskey ER, Taghinia AH, Ganor O. Association of surgical risk with exogenous hormone use in transgender patients: a systematic review. JAMA Surg. 2019;154(2):109–15.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Molly B. Moravek.

Ethics declarations

Conflict of Interest

The authors have nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Medical transition for gender diverse patients

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fortin, C.N., Moravek, M.B. Medical Transition for Gender Diverse Patients. Curr Obstet Gynecol Rep (2020). https://doi.org/10.1007/s13669-020-00297-7

Download citation

Keywords

  • Transgender
  • Hormone therapy
  • Gender-affirming treatment