{"id":408,"date":"2013-12-21T11:29:34","date_gmt":"2013-12-21T16:29:34","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/endo\/?page_id=408"},"modified":"2018-05-20T15:38:08","modified_gmt":"2018-05-20T19:38:08","slug":"transgender","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/endo\/research\/transgender\/","title":{"rendered":"BUMC Transgender Medicine Research Group"},"content":{"rendered":"

Transgender individuals have unique healthcare needs, particularly those who elect to receive hormone therapy and\/or gender confirmation surgery. However to-date, very little research has been conducted on important health topics for transgender individuals that genuinely addresses their healthcare concerns and outcomes.<\/p>\n

Faculty from the BUMC Transgender Medicine and Surgery section are\u00a0engaged in clinical research to address this critical lack of knowledge on medical topics regarding transgender-identified individuals.<\/p>\n

Our research emphasis is on improving the current medical knowledge on health topics that specifically impact the transgender community, with the goal of continually improving the health and outcomes of transgender individuals who receive medical care.\u00a0Our BUMC Transgender Research Group affirms the right of all individuals to be able to discuss their health concerns with practitioners who are knowledgeable and respectful towards a patient’s unique, identity-specific needs.<\/p>\n

Current Guidelines for the Hormone Treatment of Transgender Individuals<\/span><\/p>\n

Joshua D. Safer, MD<\/p>\n

Gender identity <\/strong>refers to an individual\u2019s self-perceived gender.\u00a0 This may be different than the sexual anatomy, the chromosomal sex, the gender role, or the sex recorded at birth (which usually simply reflects external genitalia at the time).<\/p>\n

Opposite to the dogma of many years, gender identity appears a durable biological phenomenon. While individuals may make choices related to other inputs in their lives, there do not seem to be external manipulations that truly cause individuals to change gender identity.<\/p>\n

Diagnosis<\/strong><\/p>\n

Diagnosis of transgender identity is straightforward among adults. Most individuals who recognize that there is a choice will be able to determine a gender identity without much doubt.\u00a0 Whether a given individual with a transgender identity wants to address the incongruence is a very personal decision relating to many other factors in life.<\/p>\n

In order to avoid a rare instance of a psychiatric condition confounding the situation to such a degree that gender identity is not clear, a mental health provider is included on the treatment team to confirm the absence of a confounder and to assist with transition related stress which can be significant.<\/p>\n

Because some children who present as transgender will not be so as adults, early medical treatment carries significant risk. The issue is problematic because individuals who wish to avail themselves of transgender treatment will find it easier at a younger age; prior to the need to reverse opposite sex characteristics developed in puberty.\u00a0 A paradigm to address the tension is to use GnRH analogs which delay puberty in a reversible fashion until a longer term plan is in place.\u00a0 GnRH analogs would be started at the first visible signs of puberty or approximately Tanner 2.<\/p>\n

Note that pre-pubertal children do not require any medical intervention. Because of the biological nature of gender identity, there does not seem to be any reason for parents to fear allowing pre-pubertal children to explore and even to live as transgender.\u00a0 The parents can be reassured that non-transgender children will not be convinced to be transgender any more than transgender children can be convinced to not be transgender.<\/p>\n

Therefore, the most successful medical treatment for patients who seek it is to change external appearance to match gender identity.<\/p>\n

Medical Treatment<\/strong><\/p>\n

Hormone treatment of transgender individuals is straightforward – following conventional hormone paradigms with the anticipated concerns and effects that are seen when using the same hormones for other purposes.<\/p>\n

Typically, female to male hormone treatment consists of testosterone to bring the serum testosterone from the female range to the male range. The doses required are similar to those used for treatment of hypogonadal males in general.<\/p>\n

100 mg IM or SQ testosterone (enanthate or cypionate) q week; gel is fine; patches are OK if tolerated (they often itch).<\/p>\n

Typically, male to female hormone treatment consists of an anti-androgen to lower testosterone levels (if testes are present) and estrogen supplementation.<\/p>\n

The anti-androgen of choice in the United States is spironolactone because of its long-term safety profile arising from its 50-year history as a potassium sparing diuretic to treat hypertension. Higher doses are used than are required for blood pressure control.\u00a0 Anticipate using up to 200 mg\/day (in divided doses if needed for the patient to tolerate).<\/p>\n

Multiple estrogen options exist. The 2 most popular are Premarin (conjugated estrogens originally obtained from horse urine) and estradiol (a pure laboratory produced product).\u00a0 The former is available virtually anywhere.\u00a0 The latter is cheapest.\u00a0 Anticipate doses double to quadruple those for post-menopause for true replacement of a larger woman (i.e. 2 mg instead of 0.625 mg).\u00a0 The doses sometimes need to be higher yet for individuals with testes present (4 mg\/day or more) in order to achieve female level testosterone levels.<\/p>\n

Endpoints<\/strong><\/p>\n

The endpoints for female to male treatment:<\/p>\n