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| == Transgender hormone therapy ==
| | #REDIRECT [[Gender-affirming hormone therapy]] |
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| [[File:MTF hormone replacement therapy before after.png|thumb|MTF hormone replacement therapy before after]]
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| '''Transgender hormone therapy''', also sometimes called '''cross-sex hormone therapy''', is a form of [[hormone therapy]] in which [[sex hormone]]s and other [[sex-hormonal agent|hormonal medication]]s are administered to [[transgender]] or [[gender nonconforming]] individuals for the purpose of more closely aligning their [[secondary sexual characteristic]]s with their [[gender identity]]. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is [[feminization (biology)|feminization]] or [[masculinization]]:
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| * [[Feminizing hormone therapy]] – for [[transgender women]] or [[transfeminine]] people; consists of [[estrogen (medication)|estrogen]]s and [[antiandrogen]]s
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| * [[Masculinizing hormone therapy]] – for [[Trans man|transgender men]] or transmasculine people; consists of [[androgen]]s
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| Some [[intersex]] people may also undergo hormone therapy, either starting in childhood to confirm the [[sex assignment|sex they were assigned at birth]], or later in order to align their [[sex]] with their gender identity. Non-binary or [[genderqueer]] people may also undergo hormone therapy in order to achieve a desired balance of sex hormones.<ref name="Ferguson">{{cite journal|last1=Ferguson|first1=Joshua M.|title=What It Means to Transition When You're Non-Binary|journal=Teen Vogue|date=November 30, 2017|url=https://www.teenvogue.com/story/non-binary-transitioning}}</ref>
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| ==Requirements==
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| The formal requirements for hormone replacement therapy vary widely.
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| Historically, many health centers required a psychiatric evaluation and/or a letter from a therapist before beginning therapy. Many centers how use an [[informed consent]] model that does not require any routine formal psychiatric evaluation but instead focuses on reducing barriers to care by ensuring a person can understand the risks, benefits, alternatives, unknowns, limitations, and risks of no treatment.<ref>UCSF Transgender Care, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016. Available at transcare.ucsf.edu/guidelines.</ref> Some LGBT health organizations (notably Chicago's [[Howard Brown Health Center]]<ref>{{cite web|last=Schreiber|first=Leslie|title=Howard Brown Health Center Establishes Transgender Hormone Protocol|url=http://www.howardbrown.org/hb_news.asp?id=1228|work=www.howardbrown.org|publisher=Howard Brown|accessdate=2011-08-25|archive-url=https://web.archive.org/web/20111008012906/http://howardbrown.org/hb_news.asp?id=1228|archive-date=2011-10-08|url-status=dead}}</ref> and [[Planned Parenthood]]<ref>{{Cite web|url=https://www.plannedparenthood.org/learn/sexual-orientation-gender/trans-and-gender-nonconforming-identities/what-do-i-need-know-about-trans-health-care|title=What Health Care & Services Do Transgender People Require?|website=www.plannedparenthood.org|access-date=2019-10-16}}</ref>) advocate for this type of informed consent model.
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| The [[Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People]] (SOC) require that the patient be referred by a mental health professional who has diagnosed the patient with persistent [[gender dysphoria]]. The Standards also require that the patient give [[informed consent]], in other words, that they consent to the treatment after being fully informed of the risks involved.<ref name="SOC">{{cite journal |author=Coleman, Eli|display-authors=etal|title=Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 |journal=International Journal of Transgenderism |date=August 2012 |volume=13 |issue=4 |pages=165–232 |doi=10.1080/15532739.2011.700873}}</ref>
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| The World Professional Association for Transgender Health (WPATH) Standards of Care, 7th edition, note that both of these approaches to care are appropriate.<ref>Deutsch MB, Feldman JL. Updated recommendations from the world professional association for transgender health standards of care. Am Fam Physician. 2013 Jan 15;87(2):89-93.</ref>
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| == Treatment options ==
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| === Guidelines ===
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| The World Professional Association for Transgender Health (WPATH) and the Endocrine Society formulated guidelines that created a foundation for health care providers to care for trans-gendered patients .<ref name=":0">{{Cite journal|last=Unger|first=Cécile A.|date=December 2016|title=Hormone therapy for transgender patients|journal=Translational Andrology and Urology|volume=5|issue=6|pages=877–884|doi=10.21037/tau.2016.09.04|issn=2223-4691|pmc=5182227|pmid=28078219}}</ref>
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| === Feminizing hormone therapy ===
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| {{See also|Transgender hormone therapy (male-to-female)}}
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| Feminizing hormone therapy usually includes medication to suppress testosterone production and induce feminization. Types of medication include testosterone blockers, estrogen, and progesterone.<ref name=":3">{{Cite web|url=https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy|title=Information on Estrogen Hormone Therapy {{!}} Transgender Care|website=transcare.ucsf.edu|access-date=2019-08-07}}</ref> Most commonly, 100 to 200 milligrams of spironolactone (Aldactone) daily in divided doses is used to decrease testosterone production. After six to eight weeks of spironolactone therapy, estrogen can be started to further suppress testosterone production and promote feminization.<ref>{{Cite web|url=https://www.mayoclinic.org/tests-procedures/mtf-hormone-therapy/about/pac-20385096|title=Feminizing hormone therapy - Mayo Clinic|website=www.mayoclinic.org|access-date=2019-08-02}}</ref> These medications, spironolactone and estrogen, can also be started at the same time depending on a person's preference in consultation with their clinician.{{citation needed|date=October 2019}}
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| === Masculinizing hormone therapy ===
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| {{See also|Transgender hormone therapy (female-to-male)}} | |
| Masculinizing hormone therapy usually includes testosterone to suppress the production of estrogen.<ref>{{Cite web|url=https://www.mayoclinic.org/tests-procedures/ftm-hormone-therapy/about/pac-20385099|title=Masculinizing hormone therapy - Mayo Clinic|website=www.mayoclinic.org|access-date=2019-08-02}}</ref> Treatment options include oral, parenteral, implant (subcutaneous), and trans-dermal (patches, creams, gels). Dosing is patient specific and is discussed with the physician.<ref name=":4">{{Cite web|url=https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy|title=Information on Testosterone Hormone Therapy {{!}} Transgender Care|website=transcare.ucsf.edu|access-date=2019-08-07}}</ref> The most commonly prescribed methods are intramuscular and subcutaneous injections. This dosing can be weekly or biweekly depending on the individual patient.{{citation needed|date=October 2019}}
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| {| class="wikitable"
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| |+Treatment options for transgender Men <ref name=":0" />
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| !Route
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| !Formulation
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| !Dosing
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| |-
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| |Oral
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| |Testosterone undecanoate
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| |160–240 mg/day
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| |-
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| |Parenteral
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| |Testerone enanthate , cypionate
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| |50– 200 mg/ week
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| |-
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| |Implant
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| |Testopel
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| |75 mg/pellet
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| |-
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| |Transdermal
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| |Testosterone gel (1%)
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| Testosterone patch
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| |2.5 - 10 g/day
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| 2.5 -7.5 mg/day
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| |}
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| === Safety ===
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| Hormone therapy for transgender individuals has been shown in medical literature to be generally safe, when supervised by a qualified medical professional.<ref>{{Cite web|url=http://www.jctejournal.com/article/S2214-6237(15)00049-6/pdf|title=Weinand J, Safer J. Feb 2015. "Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals." Journal of Clinical & Translational Endocrinology (2015).|date=|website=|access-date=}}</ref> There are potential risks with hormone treatment that will be monitored through screenings and lab tests such as blood count (hemoglobin), kidney and liver function, blood sugar, potassium and cholesterol.<ref name=":4" /><ref name=":3" /> Taking more hormone than directed can lead to serious health problems such as increased risk of cancer, heart attack from thickening of the blood, blood clots, and elevated cholesterol.<ref name=":4" /><ref>{{Cite journal|last=Task Force on Oral Contraceptives|last2=Koetsawang|first2=Suporn|last3=Mandlekar|first3=A.V.|last4=Krishna|first4=Usha R.|last5=Purandare|first5=V.N.|last6=Deshpande|first6=C.K.|last7=Chew|first7=S.C.|last8=Fong|first8=Rosilind|last9=Ratnam|first9=S.S.|last10=Kovacs|first10=L.|last11=Zalanyi|first11=S.|date=May 1980|title=A randomized, double-blind study of two combined oral contraceptives containing the same progestogen, but different estrogens|url=http://dx.doi.org/10.1016/0010-7824(80)90010-4|journal=Contraception|volume=21|issue=5|pages=445–459|doi=10.1016/0010-7824(80)90010-4|issn=0010-7824}}</ref>
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| ==== Fertility consideration ====
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| Transgender hormone therapy replacement may limit fertility potential.<ref name=":1">{{Cite journal|last=TʼSjoen|first=Guy|last2=Van Caenegem|first2=Eva|last3=Wierckx|first3=Katrien|date=2013|title=Transgenderism and reproduction|journal=Current Opinion in Endocrinology, Diabetes and Obesity|volume=20|issue=6|pages=575–579|doi=10.1097/01.med.0000436184.42554.b7|issn=1752-2978|pmid=24468761}}</ref> Should a transgender individual choose to undergo [[sex reassignment surgery]], their fertility potential is lost completely.<ref name=":2">{{Cite journal|last=De Sutter|first=P.|date=2001|title=Gender reassignment and assisted reproduction: present and future reproductive options for transsexual people|journal=Human Reproduction (Oxford, England)|volume=16|issue=4|pages=612–614|doi=10.1093/humrep/16.4.612|issn=0268-1161|pmid=11278204}}</ref> Before starting any treatment, individuals may consider fertility issues and [[fertility preservation]]. Options include [[semen cryopreservation]], [[oocyte cryopreservation]], and [[ovarian tissue cryopreservation]].<ref name=":1" /><ref name=":2" />
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| A study due to be presented at ENDO 2019 (the [[Endocrine Society]]'s conference) reportedly shows that even after one year of treatment with the hormone [[Testosterone (medication)|testosterone]], a [[transgender]] man can preserve his fertility potential.<ref>{{Cite web|url=https://www.endocrine.org/news-room/2019/endo-2019---ovary-function-is-preserved-in-transgender-men-at-one-year-of-testosterone-therapy|title=Ovary function is preserved in transgender men at one year of testosterone therapy {{!}} Endocrine Society|website=www.endocrine.org|access-date=2019-03-25}}</ref>
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| ==Treatment eligibility==
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| Eligibility is determined using major diagnostic tools such as [[ICD-10 Procedure Coding System|ICD-10]] or the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM). Psychiatric conditions can commonly accompany or present similar to gender incongruence and gender dysphoria. For this reason, patients are assessed using DSM-5 criteria or ICD-10 criteria in addition to screening for psychiatric disorders. The Endocrine Society requires physicians that diagnose gender dysphoria and gender incongruence to be trained in psychiatric disorders with competency in ICD-10 and DSM-5 . The healthcare provider should also obtain a thorough assessment of the patient's mental health and identify potential psychosocial factors that can affect therapy.<ref>{{Cite journal|date=2018-07-01|title=CORRIGENDUM FOR "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline"|journal=The Journal of Clinical Endocrinology & Metabolism|volume=103|issue=7|pages=2758–2759|doi=10.1210/jc.2018-01268|pmid=29905821|issn=0021-972X}}</ref>
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| === ICD-10 ===
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| The ICD-10 system requires that patients have a diagnosis of either [[transsexual]]ism or [[Gender dysphoria in children|gender identity disorder of childhood]]. The criteria for transsexualism include:<ref name="ICD10">{{Cite web|url = http://apps.who.int/classifications/icd10/browse/2010/en#/F60-F69|title = ICD-10 Diagnostic Codes|accessdate = 2014-06-08|website = ICD-10:Version 2010|publisher = }}</ref>
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| * A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex
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| * A wish to have [[Sex reassignment surgery (male-to-female)|surgery]] and hormonal treatment to make one's body as congruent as possible with one's preferred sex
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| Individuals cannot be diagnosed with transsexualism if their symptoms are believed to be a result of another [[mental disorder]], or of a [[Genetic disorder|genetic]] or [[Chromosome abnormality|chromosomal abnormality]].{{citation needed|date=March 2019}}
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| For a child to be diagnosed with gender identity disorder of childhood under ICD-10 criteria, they must be [[pre-pubescent]] and have intense and persistent distress about being the opposite sex. The distress must be present for at least six months. The child must either:
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| * Have a preoccupation with stereotypical activities of the opposite sex – as shown by [[cross-dressing]], simulating attire of the opposite sex, or an intense desire to join in the games and pastimes of the opposite sex – and reject stereotypical games and pastimes of the same sex, or
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| * Have persistent denial relating to their anatomy. This can be shown through a belief that they will grow up to be the opposite sex, that their genitals are disgusting or will disappear, or that it would be better not to have their genitals.
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| ===DSM===
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| The [[DSM-5]] states that at least two of the following criteria must be experienced for at least six months' duration for a diagnosis of [[gender dysphoria]]:<ref name="DSM5">{{cite book |author1=American Psychiatry Association |title=Diagnostic and Statistical Manual of Mental Disorders (DSM-5) |date=2013 |publisher=American Psychiatric Publishing |location=Washington, DC and London |isbn=978-0-89042-555-8 |pages=451–460 |edition=5th}}</ref>
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| <!--Note that these are paraphrased from the original to avoid copyright violation.-->
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| * A strong desire to be of a gender other than one's assigned gender
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| * A strong desire to be treated as a gender other than one's assigned gender
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| * A significant incongruence between one's experienced or expressed gender and one's [[sexual characteristics]]
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| * A strong desire for the sexual characteristics of a gender other than one's assigned gender
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| * A strong desire to be rid of one's sexual characteristics due to incongruence with one's experienced or expressed gender
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| * A strong conviction that one has the typical reactions and feelings of a gender other than one's assigned gender
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| In addition, the condition must be associated with clinically significant distress or impairment.<ref name="DSM5" />
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| ===Readiness===
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| {{See also|Real-life experience (transgender)}}
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| Some organizations – but fewer than in the past – require that patients spend a certain period of time living in their desired gender role before starting hormone therapy. This period is sometimes called real-life experience (RLE). The [[Endocrine Society]] stated in 2009 that individuals should either have a documented three months of RLE or undergo psychotherapy for a period of time specified by their mental health provider, usually a minimum of three months.<ref name="Hembree">{{cite journal|last1=Hembree|first1=Wylie, C|last2=Cohen-Kettenis|first2=Peggy|last3=Delemarre-van de Waal|first3=Henriette|last4=Gooren|first4=Louis|last5=Meyer III|first5=Walter|last6=Spack|first6=Norman|last7=Tangpricha|first7=Vin|last8=Montori|first8=Victor|title=Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline|journal=Clinical Endocrinology & Metabolism|date=September 2009|volume=94|issue=9|pages=3132–54|url=http://www.endocrine.org/~/media/endosociety/Files/Publications/Clinical%20Practice%20Guidelines/Endocrine-Treatment-of-Transsexual-Persons.pdf|archive-url=https://perma-archives.org/warc/20160311160903/https://www.endocrine.org/~/media/endosociety/Files/Publications/Clinical%20Practice%20Guidelines/Endocrine-Treatment-of-Transsexual-Persons.pdf|url-status=dead|archive-date=2016-03-11|accessdate=2014-06-07|doi=10.1210/jc.2009-0345|pmid=19509099}}</ref>
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| Transgender and gender non-conforming activists, such as [[Kate Bornstein]], have asserted that RLE is psychologically harmful and is a form of "gatekeeping", effectively barring individuals from transitioning for as long as possible, if not permanently.<ref>{{cite book|last1=Bornstein|first1=Kate|title=My Gender Workbook, Updated : How to Become a Real Man, a Real Woman, the Real You, or Something Else Entirely.|date=2013|publisher=Routledge|location=New York|isbn=978-0415538657|edition=2nd}}</ref>
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| ==Accessibility==
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| Some transgender people choose to self-administer hormone replacement medications, often because doctors have too little experience in this area, or because no doctor is available. Others self-administer because their doctor will not prescribe hormones without a letter from a psychotherapist stating that the patient meets the diagnostic criteria and is making an informed decision to transition. Many therapists require at least three months of continuous psychotherapy and/or real-life experience before they will write such a letter. Because many individuals must pay for evaluation and care [[Out-of-pocket expenses|out-of-pocket]], costs can be prohibitive.
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| Access to medication can be poor even where health care is provided free. In a patient survey conducted by the [[United Kingdom]]'s [[National Health Service]] in 2008, 5% of respondents acknowledged resorting to self-medication, and 46% were dissatisfied with the amount of time it took to receive hormone therapy. The report concluded in part: "The NHS must provide a service that is easy to access so that vulnerable patients do not feel forced to turn to DIY remedies such as buying drugs online with all the risks that entails. Patients must be able to access professional help and advice so that they can make informed decisions about their care, whether they wish to take the NHS or private route without putting their health and indeed their lives in danger."<ref>{{Cite web|url = http://www.gires.org.uk/assets/Medpro-Assets/AIAUSatisfactionAuditJune2008.pdf|title = Survey of Patient Satisfaction with Transgender Services|accessdate = 2016-01-08|archive-url = https://web.archive.org/web/20160304073200/http://www.gires.org.uk/assets/Medpro-Assets/AIAUSatisfactionAuditJune2008.pdf|archive-date = 2016-03-04|url-status = dead}}</ref> Self-administration of hormone replacement medications may have untoward health effects and risks.<ref name="pmid10604171">{{cite journal | vauthors = Becerra Fernández A, de Luis Román DA, Piédrola Maroto G | title = Morbilidad en pacientes transexuales con autotratamiento hormonal para cambio de sexo | trans-title = Morbidity in transsexual patients with cross-gender hormone self-treatment | language = Spanish| journal = Med Clin (Barc) | volume = 113 | issue = 13 | pages = 484–7 | date = October 1999 | issn = 0025-7753 | pmid = 10604171 | doi = | url = https://www.saludtrans.cl/wp-content/uploads/2012/10/morbilidad-automedicacic3b3n-en-transexuales.pdf}}</ref>
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| ==See also==
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| {{Portal|Transgender}}
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| * [[Hormone therapy]]
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| * [[Sex reassignment surgery]]
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| ==References==
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| {{Reflist|30em}}
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| {{Pharmacological body modification}}
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| {{Androgens and antiandrogens}}
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| {{Estrogens and antiestrogens}}
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| {{Progestogens and antiprogestogens}}
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| {{Gonadotropins and GnRH}}
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| {{stub}}
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| {{DEFAULTSORT:Hormone Replacement Therapy (Transgender)}}
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| [[Category:Endocrine procedures]]
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| [[Category:Gender transitioning]]
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| [[Category:Transgender and medicine]]
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