Endocrinology for Transgender Adults

Endocrinologists—or doctors who specialize in treating hormonal conditions—play a vital role in assisting transgender patients during the transition process. Quality care for transgender patients is holistic and multi-faceted, typically encompassing gender therapy, hormone replacement therapy (HRT), and surgical procedures. Ideally, a patient will begin their transition journey by seeking treatment with a mental health therapist who is skilled in working with transgender patients. From there, your therapist can refer you to an endocrinologist to begin HRT.

Sex hormones, such as estrogen and testosterone, are responsible for the physical characteristics that we typically think of as feminine or masculine (breast development in women and facial hair in men, for example). Therefore, HRT can be prescribed to assist transgender patients in achieving physical characteristics that are congruent with their experienced gender. HRT is an important and necessary first step in beginning the physical transition process to male or female—without HRT, physical transition is not possible.

Gender dysphoria, or the mental anguish and anxiety associated with being transgender, typically decreases (or even disappears altogether) when patients begin HRT. Research suggests that the brains of transgender individuals tend to be wired more similarly to those of their experienced gender than those of their assigned gender. For example, imaging studies show that the brains of transwomen are structurally aligned with those of ciswomen. Accordingly, experts believe that a transwoman’s brain may have hormone receptors that are being starved of estrogen that the body is not producing. When this estrogen deficiency is treated with HRT, gender dysphoria symptoms are improved.

HRT can be initiated at any age following immediately prior to or after puberty. However, this treatment may be more effective in patients who begin HRT at an earlier age. This is because younger patients have had less exposure to the effects of the hormones that correspond to their assigned birth gender—dubbed masculinization or femininization. For example, a transman who begins transitioning in his late teens has been exposed to the feminizing effects of estrogen for only five years or so, while a transman who begins this process in his forties has been exposed to estrogen for more than 25 years. Nevertheless, transgender patients at all stages of life have had success with HRT.

The standard HRT protocol for transmen includes treatment with testosterone, which is usually administered as an injection into the muscle. Transmen can expect to see results including increased muscle mass, decreased fat mass and a change in body fat composition, increased facial hair, a deepening of the voice, increased libido, and enlargement of the clitoris. Menstrual periods will also typically stop. Side effects that are associated with testosterone use include facial acne, undesired weight gain, increased red blood cell count, and psychological changes. Your endocrinologist can help you to manage any undesirable side effects that may occur with HRT.

For transwomen, the standard HRT protocol includes combined treatment with estrogen and an anti-androgen medication. “Androgen” is another term for male hormones; anti-androgen medications can reduce the levels of testosterone in the body and allow the estrogen to have its fullest effect. Estrogen may be prescribed as an oral pill, a topical gel or patch, or as an injection, and should be taken daily for optimal results. Transwomen who begin HRT can expect to see breast development; increased fat deposits on the hips, thighs and buttocks; softening of the skin; decreased facial and body hair; and shrinking of the testes. Side effects of treatment with estrogen include mood changes; loss of libido; an increased risk for blood clots, liver disorders, and high blood pressure; as well as a risk of breast cancer that is similar to that of ciswomen.

At the International Center for Transgender Care, we believe that our patients are the experts in their own transition journey. Because we want you to achieve the very best results from your HRT, we encourage you to discuss any questions you may have with your endocrinologist. Patients should understand the risks, benefits, and expected results of HRT prior to beginning treatment, so please do not hesitate to share any concerns you may have with our treatment team.

While HRT is a fundamental aspect of transgender care, surveys of endocrinologists in the United States suggest that many of these physicians are not prepared to offer appropriate treatment to their transgender patients. This is likely due to the fact that many endocrinologists have not received adequate training on transgender issues—in fact, the results of a recent study found that 80% of endocrinologists reported receiving no training whatsoever on treating transgender patients. Another study found that only half of these specialists were familiar with the professional guidelines for transgender endocrinology care. Fortunately, research suggests that younger physicians tend to be more knowledgeable and comfortable with providing transgender care, signifying that the trend in medicine is likely moving towards a more transgender-positive approach.

HRT is a vital component of the gender transition process, offering many physical and psychological benefits. Because HRT is such an important treatment, it is paramount to work with only the most expert endocrinologists. At the International Center for Transgender Care, we can provide you with referrals to our large network of board-certified endocrinologists who are knowledgeable and experienced in caring for transgender patients. We look forward to assisting you in achieving the very best possible results from your hormone replacement therapy. Contact us today to schedule a consultation at (972) 543-2477.

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