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Endocrine Care of Transgender Adults

Part of the Contemporary Endocrinology book series (COE)

Abstract

Since the mid-twentieth century, transgender individuals have become increasingly visible. Strong advocacy group efforts and increasing government support have improved access to medical care for people with gender dysphoria. Physicians should be aware of the unique conditions and challenges affecting this population. Healthcare professional organizations such as the American Medical Association (AMA), the Endocrine Society, and the World Professional Association for Transgender Health have concluded that hormonal and surgical treatment of gender dysphoria is medically necessary to prevent long-term morbidity. Furthermore, physicians caring for transgender persons must have sufficient experience to recognize gender dysphoria as a spectrum of conditions, and should be adept in tailoring therapy to the individual patient. Many, but not all, gender dysphoric individuals presenting for care will ultimately seek endocrine therapy for the modulation of endogenous hormone production and exogenous hormone supplementation, to improve their quality of life.

Keywords

  • Testosterone
  • Transgender
  • Treatment
  • Sex
  • Therapy
  • Gender
  • Hormone
  • Estrogen

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References

  1. Leinung MC, et al. Endocrine treatment of transsexual persons: extensive personal experience. Endocr Pract. 2013;19(4):644–50.

    PubMed  Google Scholar 

  2. Hembree WC, et al. Endocrine treatment of transsexual persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–54.

    CAS  PubMed  Google Scholar 

  3. Spack NP, et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics. 2012;129(3):418–25.

    PubMed  Google Scholar 

  4. de Vries AL, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: the Dutch approach. J Homosex. 2012;59(3):301–20.

    PubMed  Google Scholar 

  5. Steensma TD, et al. Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clin Child Psychol Psychiatry. 2011;16(4):499–516.

    Google Scholar 

  6. Smith KP, Madison CM, Milne NM. Gonadal suppressive and cross-sex hormone therapy for gender dysphoria in adolescents and adults. Pharmacotherapy. 2014;34(12):1282–97.

    CAS  PubMed  Google Scholar 

  7. Schagen SE, et al. Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. J Sex Med. 2016;13(7):1125–32.

    PubMed  Google Scholar 

  8. Carswell JM, Roberts SA. Induction and maintenance of amenorrhea in transmasculine and nonbinary adolescents. Transgender Health. 2017;2(1):195–201.

    PubMed  PubMed Central  Google Scholar 

  9. Hembree WC, 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.

    PubMed  Google Scholar 

  10. Tangpricha V, den Heijer M. Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol. 2017;5(4):291–300.

    CAS  PubMed  Google Scholar 

  11. Costa EM, Mendonca BB. Clinical management of transsexual subjects. Arq Bras Endocrinol Metabol. 2014;58(2):188–96.

    PubMed  Google Scholar 

  12. Israel GE, Tarver DE. Transgender care: recommended guidelines, practical information, and personal accounts. Philadelphia: Temple University Press; 1997. xviii, 282 p.

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  14. Meriggiola MC, Berra M. Safety of hormonal treatment in transgenders. Curr Opin Endocrinol Diabetes Obes. 2013;20(6):565–9.

    CAS  PubMed  Google Scholar 

  15. Spack NP. Management of transgenderism. JAMA. 2013;309(5):478–84.

    CAS  PubMed  Google Scholar 

  16. Meriggiola MC, et al. Endocrine treatment of transsexual persons: an endocrine society clinical practice guideline: commentary from a European perspective. Eur J Endocrinol. 2010;162(5):831–3.

    CAS  PubMed  Google Scholar 

  17. Murad MH, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf). 2010;72(2):214–31.

    Google Scholar 

  18. Unger CA. Care of the transgender patient: the role of the gynecologist. Am J Obstet Gynecol. 2014;210(1):16–26.

    PubMed  Google Scholar 

  19. Seal LJ, et al. Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens. J Clin Endocrinol Metab. 2012;97(12):4422–8.

    CAS  PubMed  Google Scholar 

  20. Wierckx K, 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 

  21. Knezevich EL, Viereck LK, Drincic AT. Medical management of adult transsexual persons. Pharmacotherapy. 2012;32(1):54–66.

    CAS  PubMed  Google Scholar 

  22. Godano A, et al. SIAMS-ONIG consensus on hormonal treatment in gender identity disorders. J Endocrinol Invest. 2009;32(10):857–64.

    CAS  PubMed  Google Scholar 

  23. Meriggiola MC, Berra M. Long-term cross-sex hormone treatment is safe in transsexual subjects. Asian J Androl. 2012;14(6):813–4.

    PubMed  Google Scholar 

  24. 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 

  25. 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 

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

    CAS  PubMed  Google Scholar 

  27. Gooren L. Hormone treatment of the adult transsexual patient. Horm Res. 2005;64(Suppl 2):31–6.

    CAS  PubMed  Google Scholar 

  28. Levy A, Crown A, Reid R. Endocrine intervention for transsexuals. Clin Endocrinol (Oxf). 2003;59(4):409–18.

    CAS  Google Scholar 

  29. Tangpricha V, et al. Endocrinologic treatment of gender identity disorders. Endocr Pract. 2003;9(1):12–21.

    PubMed  Google Scholar 

  30. 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 (Oxf). 2015;83(5):597–606.

    CAS  Google Scholar 

  31. Meriggiola MC, Gava G. Endocrine care of transpeople part II. A review of cross-sex hormonal treatments, outcomes and adverse effects in transwomen. Clin Endocrinol (Oxf). 2015;83(5):607–15.

    CAS  Google Scholar 

  32. Wylie K, et al. Serving transgender people: clinical care considerations and service delivery models in transgender health. Lancet. 2016;388(10042):401–11.

    PubMed  Google Scholar 

  33. Feldman J, et al. Priorities for transgender medical and healthcare research. Curr Opin Endocrinol Diabetes Obes. 2016;23(2):180–7.

    PubMed  PubMed Central  Google Scholar 

  34. Dittrich R, et al. Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist. Exp Clin Endocrinol Diabetes. 2005;113(10):586–92.

    CAS  PubMed  Google Scholar 

  35. Gava G, et al. Cyproterone acetate vs leuprolide acetate in combination with transdermal oestradiol in transwomen: a comparison of safety and effectiveness. Clin Endocrinol (Oxf). 2016;85(2):239–46.

    CAS  Google Scholar 

  36. Wilczynski C, Emanuele MA. Treating a transgender patient: overview of the guidelines. Postgrad Med. 2014;126(7):121–8.

    PubMed  Google Scholar 

  37. Bourguignon JP, et al. Treatment of central precocious puberty with an intranasal analogue of GnRH (Buserelin). Eur J Pediatr. 1987;146(6):555–60.

    CAS  PubMed  Google Scholar 

  38. Rappaport R, Fontoura M, Brauner R. Treatment of central precocious puberty with an LHRH agonist (Buserelin): effect on growth and bone maturation after three years of treatment. Horm Res. 1987;28(2–4):149–54.

    CAS  PubMed  Google Scholar 

  39. Kjeld JM, et al. Effects of norgestrel and ethinyloestradiol ingestion on serum levels of sex hormones and gonadotrophins in men. Clin Endocrinol (Oxf). 1979;11(5):497–504.

    CAS  Google Scholar 

  40. Raudrant D, Rabe T. Progestogens with antiandrogenic properties. Drugs. 2003;63(5):463–92.

    CAS  PubMed  Google Scholar 

  41. Toorians AW, et al. Venous thrombosis and changes of hemostatic variables during cross-sex hormone treatment in transsexual people. J Clin Endocrinol Metab. 2003;88(12):5723–9.

    CAS  PubMed  Google Scholar 

  42. Vita R, et al. Changes in hormonal and metabolic parameters in transgender subjects on cross-sex hormone therapy: a cohort study. Maturitas. 2018;107:92–6.

    CAS  PubMed  Google Scholar 

  43. 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 

  44. Orentreich N, Durr NP. Proceedings: mammogenesis in transsexuals. J Invest Dermatol. 1974;63(1):142–6.

    CAS  PubMed  Google Scholar 

  45. Moore E, Wisniewski A, Dobs A. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects. J Clin Endocrinol Metab. 2003;88(8):3467–73.

    CAS  PubMed  Google Scholar 

  46. Gil M, et al. Risk of meningioma among users of high doses of cyproterone acetate as compared with the general population: evidence from a population-based cohort study. Br J Clin Pharmacol. 2011;72(6):965–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Ter Wengel PV, et al. Meningiomas in three male-to-female transgender subjects using oestrogens/progestogens and review of the literature. Andrologia. 2016;48(10):1130–7.

    PubMed  Google Scholar 

  48. Gazzeri R, Galarza M, Gazzeri G. Growth of a meningioma in a transsexual patient after estrogen-progestin therapy. N Engl J Med. 2007;357(23):2411–2.

    CAS  PubMed  Google Scholar 

  49. Levy J, et al. Interaction of spironolactone with oestradiol receptors in cytosol. J Endocrinol. 1980;84(3):371–9.

    CAS  PubMed  Google Scholar 

  50. 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 

  51. Mosenkis A, Townsend RR. Gynecomastia and antihypertensive therapy. J Clin Hypertens (Greenwich). 2004;6(8):469–70.

    Google Scholar 

  52. Kreukels BPC, Steensma TD, de Vries ALC. Gender dysphoria and disorders of sex development: progress in care and knowledge. In: Focus on sexuality research. New York; Heidelberg: Springer; 2014. xxxii, 357 p.

    Google Scholar 

  53. Moretti C, et al. Combined oral contraception and bicalutamide in polycystic ovary syndrome and severe hirsutism: a double-blind randomized controlled trial. Moretti C1, Guccione L1, Di Giacinto P1, Simonelli I2, Exacoustos C3, Toscano V4, Motta C4, De Leo V5, Petraglia F5, Lenzi A6. J Clin Endocrinol Metab. 2018;103(3):824–38.

    Google Scholar 

  54. Muderris II, et al. New alternative treatment in hirsutism: bicalutamide 25 mg/day. Gynecol Endocrinol. 2002;16(1):63–6.

    CAS  PubMed  Google Scholar 

  55. Calaf J, et al. Long-term efficacy and tolerability of flutamide combined with oral contraception in moderate to severe hirsutism: a 12-month, double-blind, parallel clinical trial. J Clin Endocrinol Metab. 2007;92(9):3446–52.

    CAS  PubMed  Google Scholar 

  56. Castelo-Branco C, et al. Long-term safety and tolerability of flutamide for the treatment of hirsutism. Fertil Steril. 2009;91(4):1183–8.

    CAS  PubMed  Google Scholar 

  57. Dikensoy E, et al. The risk of hepatotoxicity during long-term and low-dose flutamide treatment in hirsutism. Arch Gynecol Obstet. 2009;279(3):321–7.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  59. Available from: http://transhealth.ucsf.edu/trans?page=guidelines-feminizing-therapy (2/15/2018).

  60. Ettner R. Care of the elderly transgender patient. Curr Opin Endocrinol Diabetes Obes. 2013;20(6):580–4.

    PubMed  Google Scholar 

  61. Mepham N, et al. People with gender dysphoria who self-prescribe cross-sex hormones: prevalence, sources, and side effects knowledge. J Sex Med. 2014;11(12):2995–3001.

    PubMed  Google Scholar 

  62. de Blok CJM, et al. Breast development in transwomen after 1 year of cross-sex hormone therapy: results of a prospective multicenter study. J Clin Endocrinol Metab. 2018;103(2):532–8.

    PubMed  Google Scholar 

  63. Canonico M, et al. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. 2008;336(7655):1227–31.

    PubMed  PubMed Central  Google Scholar 

  64. Asscheman H, et al. Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: a review. Andrologia. 2014;46(7):791–5.

    CAS  PubMed  Google Scholar 

  65. van Kesteren PJ, et al. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol (Oxf). 1997;47(3):337–42.

    Google Scholar 

  66. Costa R, Colizzi M. The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: a systematic review. Neuropsychiatr Dis Treat. 2016;12:1953–66.

    PubMed  PubMed Central  Google Scholar 

  67. Rossouw JE, et al. Inflammatory, lipid, thrombotic, and genetic markers of coronary heart disease risk in the women’s health initiative trials of hormone therapy. Arch Intern Med. 2008;168(20):2245–53.

    CAS  PubMed  PubMed Central  Google Scholar 

  68. Miller VT, et al. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The postmenopausal estrogen/progestin interventions (PEPI) trial. The writing group for the PEPI trial. JAMA. 1995;273(3):199–208. https://doi.org/10.1001/jama.1995.03520270033028.

    Google Scholar 

  69. Ott J, et al. Cross-sex hormone therapy alters the serum lipid profile: a retrospective cohort study in 169 transsexuals. J Sex Med. 2011;8(8):2361–9.

    CAS  PubMed  Google Scholar 

  70. Singh-Ospina N, et al. Effect of sex steroids on the bone health of transgender individuals: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2017;102(11):3904–13.

    PubMed  Google Scholar 

  71. Elbers JM, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol (Oxf). 2003;58(5):562–71.

    CAS  Google Scholar 

  72. Wierckx 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 

  73. Kovacs K, et al. 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 

  74. Serri O, et al. Lactotroph hyperplasia in an estrogen treated male-to-female transsexual patient. J Clin Endocrinol Metab. 1996;81(9):3177–9.

    CAS  PubMed  Google Scholar 

  75. Cunha FS, 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 

  76. Freda PU, et al. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(4):894–904.

    CAS  PubMed  PubMed Central  Google Scholar 

  77. Giltay EJ, et al. Sex steroids, insulin, and arterial stiffness in women and men. Hypertension. 1999;34(4 Pt 1):590–7.

    CAS  PubMed  Google Scholar 

  78. Boldo A, White WB. Blood pressure effects of the oral contraceptive and postmenopausal hormone therapies. Endocrinol Metab Clin North Am. 2011;40(2):419–32, ix.

    CAS  PubMed  Google Scholar 

  79. Wierckx K, et al. Sexual desire in trans persons: associations with sex reassignment treatment. J Sex Med. 2014;11(1):107–18.

    PubMed  Google Scholar 

  80. Steinle K. Hormonal management of the female-to-male transgender patient. J Midwifery Womens Health. 2011;56(3):293–302.

    PubMed  Google Scholar 

  81. Meyer WJ 3rd, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA. Physical and hormonal evaluation of transsexual patients: a longitudinal study. Send to Arch Sex Behav. 1986;15(2):121–38.

    PubMed  Google Scholar 

  82. Tack LJ, et al. Consecutive lynestrenol and cross-sex hormone treatment in biological female adolescents with gender dysphoria: a retrospective analysis. Biol Sex Differ. 2016;7:14.

    PubMed  PubMed Central  Google Scholar 

  83. Darney PD. The androgenicity of progestins. Am J Med. 1995;98(1A):104S–10S.

    CAS  PubMed  Google Scholar 

  84. Leder BZ, et al. Effects of aromatase inhibition in elderly men with low or borderline-low serum testosterone levels. J Clin Endocrinol Metab. 2004;89(3):1174–80.

    CAS  PubMed  Google Scholar 

  85. T’Sjoen GG, et al. Comparative assessment in young and elderly men of the gonadotropin response to aromatase inhibition. J Clin Endocrinol Metab. 2005;90(10):5717–22.

    PubMed  Google Scholar 

  86. Ott J, et al. Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy. Fertil Steril. 2010;93(4):1267–72.

    PubMed  Google Scholar 

  87. Buckler HM, et al. The effects of low-dose testosterone treatment on lipid metabolism, clotting factors and ultrasonographic ovarian morphology in women. Clin Endocrinol (Oxf). 1998;49(2):173–8.

    CAS  Google Scholar 

  88. Gorton RN, Buth J, Spade D. Medical therapy and health maintenance for transgender men: a guide for health care providers. San Francisco, CA: Lyon-Martin Women’s Health Services; 2005. http://www.lyon-martin.org

  89. Coviello AD, et al. Effects of graded doses of testosterone on erythropoiesis in healthy young and older men. J Clin Endocrinol Metab. 2008;93(3):914–9.

    CAS  PubMed  Google Scholar 

  90. Dickerman RD, et al. Androgen-induced erythrocytosis: is it erythropoietin? Am J Hematol. 1999;61(2):154–5.

    CAS  PubMed  Google Scholar 

  91. Dobs AS, et al. Pharmacokinetics, efficacy, and safety of a permeation-enhanced testosterone transdermal system in comparison with bi-weekly injections of testosterone enanthate for the treatment of hypogonadal men. J Clin Endocrinol Metab. 1999;84(10):3469–78.

    CAS  PubMed  Google Scholar 

  92. Mueller A, et al. 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 

  93. Gooren LJ. Management of female-to-male transgender persons: medical and surgical management, life expectancy. Curr Opin Endocrinol Diabetes Obes. 2014;21(3):233–8.

    PubMed  Google Scholar 

  94. Asscheman H, et al. 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 

  95. Gooren LJ, Giltay EJ. Men and women, so different, so similar: observations from cross-sex hormone treatment of transsexual subjects. Andrologia. 2014;46(5):570–5.

    CAS  PubMed  Google Scholar 

  96. Costantino A, et al. A prospective study on sexual function and mood in female-to-male transsexuals during testosterone administration and after sex reassignment surgery. J Sex Marital Ther. 2013;39(4):321–35.

    PubMed  Google Scholar 

  97. Mueller A, et al. Effects of intramuscular testosterone undecanoate on body composition and bone mineral density in female-to-male transsexuals. J Sex Med. 2010;7(9):3190–8.

    CAS  PubMed  Google Scholar 

  98. Dhejne C, et al. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS ONE. 2011;6(2):e16885.

    CAS  PubMed  PubMed Central  Google Scholar 

  99. Wierckx K, et al. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study. Eur J Endocrinol. 2013;169(4):471–8.

    CAS  PubMed  Google Scholar 

  100. Deutsch MB, Feldman JL. Updated recommendations from the world professional association for transgender health standards of care. Am Fam Physician. 2013;87(2):89–93.

    PubMed  Google Scholar 

  101. Polderman KH, et al. Induction of insulin resistance by androgens and estrogens. J Clin Endocrinol Metab. 1994;79(1):265–71.

    CAS  PubMed  Google Scholar 

  102. Berra M, et al. Testosterone decreases adiponectin levels in female to male transsexuals. Asian J Androl. 2006;8(6):725–9.

    CAS  PubMed  Google Scholar 

  103. Colizzi M, et al. Concomitant psychiatric problems and hormonal treatment induced metabolic syndrome in gender dysphoria individuals: a 2 year follow-up study. J Psychosom Res. 2015;78(4):399–406.

    PubMed  Google Scholar 

  104. Pelusi C, 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 

  105. Dunaif A, et al. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989;38(9):1165–74.

    CAS  PubMed  Google Scholar 

  106. Fernandez JD, Tannock LR. Metabolic effects of hormone therapy in transgender patients. Endocr Pract. 2016;22(4):383–8.

    PubMed  Google Scholar 

  107. Emmelot-Vonk MH, et al. Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. JAMA. 2008;299(1):39–52.

    CAS  PubMed  Google Scholar 

  108. Doublier S, et al. Testosterone and 17beta-estradiol have opposite effects on podocyte apoptosis that precedes glomerulosclerosis in female estrogen receptor knockout mice. Kidney Int. 2011;79(4):404–13.

    CAS  PubMed  Google Scholar 

  109. Soljancic A, et al. Protective role of testosterone in ischemia-reperfusion-induced acute kidney injury. Am J Physiol Regul Integr Comp Physiol. 2013;304(11):R951–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  110. Ikeda K, et al. Excessive androgen exposure in female-to-male transsexual persons of reproductive age induces hyperplasia of the ovarian cortex and stroma but not polycystic ovary morphology. Hum Reprod. 2013;28(2):453–61.

    CAS  PubMed  Google Scholar 

  111. Galazis N, et al. Proteomic biomarkers for ovarian cancer risk in women with polycystic ovary syndrome: a systematic review and biomarker database integration. Fertil Steril. 2012;98(6):1590–601 e1.

    Google Scholar 

  112. Grynberg M, 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  Google Scholar 

  113. Baba T, et al. Association between polycystic ovary syndrome and female-to-male transsexuality. Hum Reprod. 2007;22(4):1011–6.

    PubMed  Google Scholar 

  114. Pache TD, Fauser BC. Polycystic ovaries in female-to-male transsexuals. Clin Endocrinol (Oxf). 1993;39(6):702–3.

    CAS  Google Scholar 

  115. Coleman E, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232.

    Google Scholar 

  116. Slagter MH, et al. Effects of long-term androgen administration on breast tissue of female-to-male transsexuals. J Histochem Cytochem. 2006;54(8):905–10.

    CAS  PubMed  Google Scholar 

  117. Gooren LJ, et al. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med. 2013;10(12):3129–34.

    PubMed  Google Scholar 

  118. Gooren L, et al. Five new cases of breast cancer in transsexual persons. Andrologia. 2015;47(10):1202–5.

    CAS  PubMed  Google Scholar 

  119. Shao T, Grossbard ML, Klein P. Breast cancer in female-to-male transsexuals: two cases with a review of physiology and management. Clin Breast Cancer. 2011;11(6):417–9.

    PubMed  Google Scholar 

  120. Burcombe RJ, et al. Breast cancer after bilateral subcutaneous mastectomy in a female-to-male trans-sexual. Breast. 2003;12(4):290–3.

    CAS  PubMed  Google Scholar 

  121. Nikolic DV, et al. Importance of revealing a rare case of breast cancer in a female to male transsexual after bilateral mastectomy. World J Surg Oncol. 2012;10:280.

    PubMed  PubMed Central  Google Scholar 

  122. Mahan RJ, et al. Drug therapy for gender transitions and health screenings in transgender older adults. J Am Geriatr Soc. 2016;64(12):2554–9.

    PubMed  Google Scholar 

  123. Primary care protocol for transgender patient care. Center of Excellence for Transgender Health, University of California, San Francisco, Department of Family and Community Medicine. [online] available at http://transhealth.ucsf.edu/protocols (2011). Accessed 5 Feb 2018.

  124. Baldassarre M, et al. Effects of long-term high dose testosterone administration on vaginal epithelium structure and estrogen receptor-alpha and -beta expression of young women. Int J Impot Res. 2013;25(5):172–7.

    CAS  PubMed  Google Scholar 

  125. Roberts TK, et al. Interpreting laboratory results in transgender patients on hormone therapy. Am J Med. 2014;127(2):159–62.

    PubMed  Google Scholar 

  126. Callewaert F, et al. Skeletal sexual dimorphism: relative contribution of sex steroids, GH-IGF1, and mechanical loading. J Endocrinol. 2010;207(2):127–34.

    CAS  PubMed  Google Scholar 

  127. Lips P, et al. The effect of androgen treatment on bone metabolism in female-to-male transsexuals. J Bone Miner Res. 1996;11(11):1769–73.

    CAS  PubMed  Google Scholar 

  128. Van Caenegem E, et al. Bone mass, bone geometry, and body composition in female-to-male transsexual persons after long-term cross-sex hormonal therapy. J Clin Endocrinol Metab. 2012;97(7):2503–11.

    PubMed  Google Scholar 

  129. Ruetsche AG, et al. Cortical and trabecular bone mineral density in transsexuals after long-term cross-sex hormonal treatment: a cross-sectional study. Osteoporos Int. 2005;16(7):791–8.

    PubMed  Google Scholar 

  130. Turner A, et al. Testosterone increases bone mineral density in female-to-male transsexuals: a case series of 15 subjects. Clin Endocrinol (Oxf). 2004;61(5):560–6.

    CAS  Google Scholar 

  131. Van Caenegem E, 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 

  132. Van Caenegem E, et al. Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study. Osteoporos Int. 2015;26(1):35–47.

    PubMed  Google Scholar 

  133. Fischer EM, et al. Severe osteoporosis with multiple vertebral fractures after gender reassignment therapy—is it male or female osteoporosis? Gynecol Endocrinol. 2011;27(5):341–4.

    PubMed  Google Scholar 

  134. Amin S, et al. Association of hypogonadism and estradiol levels with bone mineral density in elderly men from the Framingham study. Ann Intern Med. 2000;133(12):951–63.

    CAS  PubMed  Google Scholar 

  135. Khosla S, et al. Relationship of serum sex steroid levels to longitudinal changes in bone density in young versus elderly men. J Clin Endocrinol Metab. 2001;86(8):3555–61.

    CAS  PubMed  Google Scholar 

  136. Argalious MY, et al. Association of testosterone replacement therapy and the incidence of a composite of postoperative in-hospital mortality and cardiovascular events in men undergoing noncardiac surgery. Anesthesiology. 2017;127(3):457–65.

    CAS  PubMed  Google Scholar 

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Fishman, S.L., Paliou, M., Poretsky, L., Hembree, W.C. (2019). Endocrine Care of Transgender Adults. In: Poretsky, L., Hembree, W. (eds) Transgender Medicine. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-030-05683-4_8

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