Replacement Hormone Therapy for Gender Dysphoria and Congenital Sexual Anomalies

  • Chapter
  • First Online:
Hormonal Pathology of the Uterus

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1242))

Abstract

What is it about sexuality that makes it such a burning matter since the dawn of mankind? Much was lost of humankind heritage because of society’s attitude toward sex and gender, but we’ve made progress. Medical knowledge progressed incredibly and so did social and cultural norms. In these days, on most places on the planet, there is acceptance. Still, gender issues take a center stage, often inflaming the social and political milieu everywhere. So how informed and prepared is the medical community to deal with these issues? Aside from medical treatments, gender dysphoric patients need mental health and social support throughout life. Do we have enough guidelines for treatments that have life-long effects? Do we actually know all of those effects? There are many issues to consider, like fertility preservation, puberty suppression with its adverse effects, and not in the least, the effects of the hormonal therapy on the target tissues.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Martine Rothblatt. The apartheid of sex.

    Google Scholar 

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. p. 451–9.

    Book  Google Scholar 

  3. Frisén L, Söder O, Rydelius PA. Dramatic increase of gender dysphoria in youth. Läkartidningen. 2017.

    Google Scholar 

  4. Cartaya J, Lopez X. Gender dysphoria in youth: a review of recent literature. Curr Opin Endocrinol Diabetes Obes. 2018;25(1):44–8.

    Article  PubMed  Google Scholar 

  5. Aitken M, Steensma TD, Blanchard R, et al. Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med. 2015;12:756–63.

    Article  PubMed  Google Scholar 

  6. Streed CG Jr, McCarthy EP, Haas JS. Association between gender minority status and self-reported physical and mental health in the United States. JAMA Intern Med. 2017;177:1210–2.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Klein DA, Paradise SL, Goodwin ET. Caring for transgender and gender-diverse persons: what clinicians should know. Am Fam Physician. 2018;98(11):645–53.

    PubMed  Google Scholar 

  8. WPATH. Clarification on medical necessity of treatment, sex reassignment, and insurance coverage for transgender and transsexual people worldwide [Internet]. http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1352&pk_association_webpage=3947

  9. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, 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.

    Article  Google Scholar 

  10. Joint R, Chen ZE, Cameron S. Breast and reproductive cancers in the transgender population: a systematic review [published online ahead of print April 28, 2018]. BJOG. 2018;125:1505. https://doi.org/10.1111/1471-0528.15258.

    Article  CAS  PubMed  Google Scholar 

  11. Maraka S, Singh Ospina N, Rodriguez-Gutierrez R, et al. Sex steroids and cardiovascular outcomes in transgender individuals: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2017;102(11):3914–23.

    Article  PubMed  Google Scholar 

  12. Singh-Ospina N, Maraka S, Rodriguez-Gutierrez R, 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.

    Article  PubMed  Google Scholar 

  13. 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. 2015;83(5):597–606.

    Article  CAS  Google Scholar 

  14. Weinand JD, Safer JD. Hormone therapy in transgender adults is safe with provider supervision; a review of hormone therapy sequelae for transgender individuals. J Clin Transl Endocrinol. 2015;2(2):55–60.

    PubMed  PubMed Central  Google Scholar 

  15. Deutsch MB. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2nd ed. 2016. http://transhealth.ucsf.edu/protocols. Accessed 5 July 2018.

  16. Endocrine Society Updates Guidelines on Transgender Medical Care. Veronica Hackenthal. 2017. www.medscape.com

  17. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine. Society clinical practice guideline [published correction appears in J Clin Endocrinol Metab. 2018;103(2):699]. J Clin Endocrinol Metab. 2017;102(11):3869–903.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  CAS  PubMed  Google Scholar 

  19. Brown GR, Jones KT. Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat. 2015;149(1):191–8.

    Article  PubMed  Google Scholar 

  20. Gooren L, Morgentaler A. Prostate cancer incidence in orchidectomised male-to-female transsexual persons treated with oestrogens. Andrologia. 2014;46(10):1156–60.

    Article  CAS  PubMed  Google Scholar 

  21. Turo R, Jallad S, Prescott S, Cross WR. Metastatic prostate cancer in transsexual diagnosed after three decades of estrogen therapy. Can Urol Assoc J. 2013;7(7–8):E544–6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Spratt DI, Stewart II, Savage C, et al. Subcutaneous injection of testosterone is an effective and preferred alternative to intramuscular injection: demonstration in female-to-male transgender patients. J Clin Endocrinol Metab. 2017;102:2349–55.

    Article  PubMed  Google Scholar 

  23. Costa LBF, Rosa-E-Silva ACJS, Medeiros SF, Nacul AP, Carvalho BR, Benetti-Pinto CL, Yela DA, Maciel GAR, Soares Júnior JM, Maranhão TMO. Recommendations for the use of testosterone in male transgender. Rev Bras Ginecol Obstet. 2018;40(5):275–80.

    Article  PubMed  Google Scholar 

  24. Wierckx K, Mueller S, Weyers S, Van Caenegem E, Roef G, Heylens G, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med. 2012;9(10):2641–51.

    Article  CAS  PubMed  Google Scholar 

  25. Urban RR, Teng NNH, Kapp DS. Gynecologic malignancies in female-to-male transgender patients: the need of original gender surveillance. Am J Obstet Gynecol. 2011;204(5):e9–12.

    Article  PubMed  Google Scholar 

  26. Grynberg M, Fanchin R, Dubost G, Colau J-C, Brémont-Weil C, Frydman R, 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.

    Article  CAS  PubMed  Google Scholar 

  27. Perrone AM, Cerpolini S, Maria Salfi NC, Ceccarelli C, De Giorgi LB, Formelli G, et al. Effect of long-term testosterone administration on the endometrium of female-to-male (FtM) transsexuals. J Sex Med. 2009;6(11):3193–200.

    Article  CAS  PubMed  Google Scholar 

  28. Dizon DS, Tejada-Berges T, Koelliker S, Steinhoff M, Granai CO. Ovarian cancer associated with testosterone supplementation in a female-to-male transsexual patient. Gynecol Obstet Investig. 2006;62(4):226–8.

    Article  Google Scholar 

  29. Hage JJ, Dekker JJ, Karim RB, Verheijen RH, Bloemena E. Ovarian cancer in female-to-male transsexuals: report of two cases. Gynecol Oncol. 2000;76(3):413–5.

    Article  CAS  PubMed  Google Scholar 

  30. Futterweit W, Deligdisch L. Histopathological effects of exogenously administered testosterone in 19 female to male transsexuals. J Clin Endocrinol Metab. 1986;62(1):16–21.

    Article  CAS  PubMed  Google Scholar 

  31. Futterweit W, Deligdisch L. Effects of androgens on the ovary. Fertil Steril. 1986;46(2):343–5.

    Article  CAS  PubMed  Google Scholar 

  32. Wierckx K, Elaut E, Declercq E, Heylens G, De Cuypere G, Taes Y, 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.

    Article  CAS  PubMed  Google Scholar 

  33. American Fertility Society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–55.

    Article  Google Scholar 

  34. Chandler TM, Machan LS, Cooperberg PL, Harris AC, Chang SD. Müllerian duct anomalies: from diagnosis to intervention. Pictorial review. Brit J Radiol. 2009;82:1034–42.

    Article  CAS  PubMed  Google Scholar 

  35. Grimbizis GF, Campo R, Gordts S, Brucker S, Gergolet M, Tanos V, et al. Clinical approach for the classification of congenital uterine malformations. Gynecol Surg. 2012;9:119–29.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Grimbizis GF, Gordts S, Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013;28:2032–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Acién P, Acién M. Diagnostic imaging and cataloguing of female genital malformations. Insights Imaging. 2016;7(5):713–26.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Witchel SF. Disorders of sex development. Best Pract Res Clin Obstet Gynaecol. 2018;48:90–102.

    Article  PubMed  Google Scholar 

  39. Lee PA, Nordenström A, Houk CP, et al. Global disorders of sex development update since 2006: perceptions, approach and care. Horm Res Paediatr. 2016;85:158–80.

    Article  CAS  PubMed  Google Scholar 

  40. Hughes IA, Nihoul-Fékété C, Thomas B, et al. Consequences of the ESPE/LWPES guidelines for diagnosis and treatment of disorders of sex development. Best Pract Res Clin Endocrinol Metab. 2007;21:351–65.

    Article  PubMed  Google Scholar 

  41. Chen MJ, McCann-Crosby B, Gunn S, et al. Fluidity models in ancient Greece and current practices of sex assignment. Semin Perinatol. 2017;41:206–13.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Patel V, Casey RK, Gomez-Lobo V. Timing of gonadectomy in patients with complete androgen insensitivity syndrome-current recommendations and future directions. J Pediatr Adolesc Gynecol. 2016;29:320–5.

    Article  PubMed  Google Scholar 

  43. Laurian L, Finkelstein JO, Soferman N, Loewenthal M, Deligdisch L. Testicular feminization syndrome. Isr J Med Sci. 1971;7(5):668–73.

    CAS  PubMed  Google Scholar 

  44. Becker D, Wain LM, Chong YH, Gosai SJ, Henderson NK, Milburn J, Stott V, Wheeler BJ. Topical dihydrotestosterone to treat micropenis secondary to partial androgen insensitivity syndrome (PAIS) before, during, and after puberty—a case series. J Pediatr Endocrinol Metab. 2016;29(2):173–7.

    Article  CAS  PubMed  Google Scholar 

  45. Altchek A, Deligdisch L. Pediatric adolescent and young adult gynecology: Blackwell Publishing; 2009.

    Google Scholar 

  46. Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. Lancet. 2015;385:607–16.

    Article  PubMed  Google Scholar 

  47. Testa G, McKenna GJ, Gunby RT Jr, et al. First live birth after uterus transplantation in the United States. Am Transplant. 2018;18:1270–4.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Angelica Mareş Miceli .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mareş Miceli, A. (2020). Replacement Hormone Therapy for Gender Dysphoria and Congenital Sexual Anomalies. In: Deligdisch-Schor, L., Mareş Miceli, A. (eds) Hormonal Pathology of the Uterus . Advances in Experimental Medicine and Biology, vol 1242. Springer, Cham. https://doi.org/10.1007/978-3-030-38474-6_7

Download citation

Publish with us

Policies and ethics

Navigation