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Urological Care for the Transgender Patient pp 23–36Cite as

Endocrinological Care for Patients Undergoing Gender Affirmation (Including Risk of Thromboembolic Events)

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Abstract

Transgender hormone therapy can play an important role in patients undergoing gender affirmation and results in improved quality of life for transgender individuals. Hormone therapy may be a step on the pathway to gender-affirming surgery, but many patients may choose to remain on hormone therapy without surgery or may not have access to surgical therapy. Basic criteria should be met prior to initiation of hormone therapy. Hormone therapy in transgender women includes estrogen and anti-androgens. Transgender men are treated primarily with exogenous testosterone supplementations. Patients should be made aware of side effects of hormone therapy prior to initiation. Close monitoring is important during the first year of therapy, and it can be less frequent thereafter. Although there is no consensus available, it is generally recommended that estradiol therapy be stopped temporarily before gender affirmation surgeries or other major surgical interventions. It is less clear whether it is necessary to hold testosterone therapy prior to surgery. Usual thromboprophylaxis measures are recommended for any gender-affirming surgeries that require extensive surgery and prolonged immobilization.

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Abbreviations

DHT:

Dihydrotestosterone

DSM:

Diagnostic and Statistical Manual of Mental Disorders

EE:

Ethinyl estradiol

GD:

Gender dysphoria

GnRH:

Gonadotrophin-releasing hormone

Hct:

Hematocrit

HDL:

High-density lipoprotein

ICD:

International Classification of Disease

LDL:

Low-density lipoprotein

QoL:

Quality of life

VTE:

Venous thromboembolism

WPATH:

World Professional Association for Transgender Health

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Authors and Affiliations

  1. SUNY Upstate Medical University, Department of Medicine, Division of Endocrinology, Syracuse, NY, USA

    Lei Lei Min & Rachel Hopkins

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  1. Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA

    Dmitriy Nikolavsky

  2. Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA

    Stephen A. Blakely

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Min, L.L., Hopkins, R. (2021). Endocrinological Care for Patients Undergoing Gender Affirmation (Including Risk of Thromboembolic Events). In: Nikolavsky, D., Blakely, S.A. (eds) Urological Care for the Transgender Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-18533-6_3

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