Sex Reassignment: Endocrinological Interventions in Adults with Gender Dysphoria

Abstract

Transgender people may wish to transition to the other sex, usually to the fullest extent possible. Part of that transition is enabled by the administration of cross-sex hormones and part by surgical adaptation. The treatment of male-to-female transgender people consists of blocking androgen action and allowing estrogens to feminize the body. For virilization of female-to-male transgender people, androgens usually suffice. In adulthood, certain features of the sex hormone-induced body shape cannot be undone (such as the larger size of bones in males, the hip configuration in females). After about 2-3 years, the maximally attainable effects of cross-sex hormones have been reached. With competent endocrinological advice, cross-sex hormone treatment is usually uneventful. The estrogen ethinyl estradiol is to be avoided in view of the risks of venous thrombosis and cardiovascular disease. Androgen administration does not lead to an increase in cardiovascular disease. Hormone-dependent cancers have been observed in transgender people but not to an alarming degree. The relative rarity of transsexualism and the scattering of endocrine treatment over many centers is an impediment to build a solid body of knowledge with regard to efficacy and safety of cross-sex hormone treatment. (PsycINFO Database Record (c) 2016 APA, all rights reserved)