Practice Therapeutics

Long term hormonal treatment for transgender people

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5027 (Published 30 November 2017) Cite this as: BMJ 2017;359:j5027
  1. Martin den Heijer, professor of endocrinology1 2,
  2. Alex Bakker, transgender man with 20 years of experience taking hormonal treatment,
  3. Louis Gooren, emeritus professor in transgender medicine2
  1. 1Department of internal medicine, VU Medical Center, Amsterdam, Netherlands
  2. 2Center of expertise on gender dysphoria, VU Medical Center, Amsterdam, Netherlands
  1. Correspondence to M den Heijer m.denheijer{at}vumc.nl

What you need to know

  • Transgender people using hormone treatment need lifelong medical support and care. Hormonal treatment for gender dysphoria resembles hormone replacement therapy for people with hypogonadism.

  • Hormone treatment in transgender people is accepted to be safe and increases overall wellbeing in most people. The most common (though rare) side effects are venous thrombosis in trans women due to oestrogens and polycythaemia caused by androgens in trans men.

  • Some trans women will not have had their prostate removed and some trans men keep their ovaries. Be aware of the risk of cancer in these sites and think about the added risk of hormone supplementation.

The aim of hormone treatment in transgender people is to adjust their secondary sex characteristics to be more congruent with their experienced gender. Hormone treatment for transgender people is usually initiated by specialist gender clinics, but some people start hormone treatment of their own accord without a prescription. With growing numbers of transgender people presenting to healthcare services (estimated as 9.2 per 100 0001), general practitioners, general endocrinologists, and other doctors will become increasingly involved in their long term care, the prescription of hormones, and consideration of potential side effects. Several guidelines are available on the start of hormonal treatment234567; the focus of this article is the long term hormonal care for transgender people who might no longer attend a specialist clinic. It is aimed at a more general readership of physicians occasionally seeing adult transgender people.

Transgender terminology

Language and terminology are sensitive. Some terms used in the past are no longer appropriate because they might have negative connotations.

Sex/gender

The term gender has historically been used to refer to psychological, behavioural, and sociological characteristics, and their categorisation by society as “masculine” or “feminine.” The term sex has historically been used to refer to …

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