Tratamiento Endocrino De Personas Transexuales

0021-972X/03/$15.00/0 Printed in U.S.A.

The Journal of Clinical Endocrinology & Metabolism 88(8):3467–3473 Copyright © 2003 by The Endocrine Society doi: 10.1210/jc.2002-021967

CLINICAL REVIEW 161 Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects
EVA MOORE, AMY WISNIEWSKI,
AND

ADRIAN DOBS

Departments of Medicine and Pediatrics,The Johns Hopkins School of Medicine, Baltimore, Maryland 21287
Cross-sex hormone treatment is an important component in medical treatment of transsexual people. Endocrinologists are often faced with designing treatment recommendations. Although guidelines from organizations, such as the Harry Benjamin International Gender Dysphoria Association, have been helpful, management remains complex andexperience guided. We discuss the range of treatment used by transsexual people, the rationale behind these, and the expectation from such treatment. Recommendations from seven clinical research centers treating transsexual people are discussed. In addition, self-reported hormonal regimens from 25 male-tofemale transsexual people and five female-to-male transsexual people are reported. Finally, thepotential adverse effects of cross-sex hormone treatment of transsexual people are reviewed. In light of the complexity of managing treatment goals and adverse effects, the active involvement of a medical doctor experienced in cross-sex hormonal therapy is vital to ensure the safety of transsexual people. (J Clin Endocrinol Metab 88: 3467–3473, 2003)

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NDOCRINOLOGISTS ARE CONSULTED in themanagement of transsexual people. Cross-sex hormonal treatment is desired by such patients to successfully live as a member of their identified gender. Endocrine treatment provides some relief from the dichotomy between body habitus and gender identity (1). Ideally, this transition should be quick and complete. However, the medical risks of sex steroids are real; thus, medical providers areconfronted with the difficult dilemma of balancing medical risks and psychological needs of patients. The prevalence of transsexual people has been determined to be as high as 1 in 11,900 males and 1 in 30,400 females (2). Standards of care for the psychological, endocrinological, and surgical management of transsexual people have been proposed by the Harry Benjamin International Gender DysphoriaAssociation, Inc. (3, 4). Specific management of hormonal regimens and long-term management, however, remain difficult to navigate. As a result, most physicians depend on observational and anecdotal reports to guide endocrine treatment. This review will discuss the endocrinological treatment of male-to-female (M3 F) and female-to-male (F3M) transsexual people. We present the specificities of cross-sexhormone treatment and the reasonable expected effects of those treatments, followed by a brief discussion of the range of treatments used by transsexual people. Our intent is to provide a rationale to guide the endocrinological care of transsexual people.
Subjects and Methods

related articles, abstracts, and bibliographies. Keywords used for the search included transsexual, transsexual people,transgender, transgendered, cross-sex, phytoestrogen, gynecomastia, spironolactone, cyproterone, tamoxifen, and testosterone. Articles in peer reviewed medical journals that suggested the use of sex steroid hormones in transsexual people were retrieved and reviewed for content, and their references were used to identify other literature of interest. Articles that reported clear dosing informationfor cross-sex hormonal treatment were evaluated. Drug information was obtained from Micromedex, a database of pharmacological agents, and PubMed to obtain generic names when trade names or European brands were reported. A total of 61 articles fit our criteria for review in this manuscript.

Subjects
In addition to reviewing the literature, we present information on transgender individuals seen...