A 25-year-old birth-gender male presents to their primary care provider stating they would like to transition to transfeminine. The patient has been dressing as a female for over a year, seeing a therapist, and has a strong support group of transgender friends. The patient is requesting estrogen therapy to feminize their features.
What medications can be prescribed to this patient?
What adverse effects could the patient receiving gender-affirming hormone therapy receive?
contain at least two citations with corresponding references no later than 2019
Title: Gender-Affirming Hormone Therapy: Medications and Potential Adverse Effects
Introduction:
Gender-affirming hormone therapy (GAHT) plays a crucial role in the medical transition of transgender individuals. For transgender women (assigned male at birth, AMAB) who desire to transition to transfeminine, estrogen therapy can be a primary component of their treatment plan. This essay will discuss the medications commonly prescribed for transfeminine individuals, as well as potential adverse effects that patients may experience during gender-affirming hormone therapy.
Medications for Transfeminine Individuals:
Estrogen: The primary medication prescribed for feminizing hormone therapy in transfeminine individuals is estrogen. Commonly used forms of estrogen include estradiol, esterified estrogens, and conjugated equine estrogen. These medications are typically administered orally or transdermally (through patches or gels). Estrogen therapy helps induce the development of feminine secondary sexual characteristics, such as breast growth, redistribution of body fat, and softening of skin texture.
Anti-androgens: In addition to estrogen therapy, anti-androgens may be prescribed to suppress the production of testosterone, the primary male sex hormone. Common anti-androgen medications include spironolactone and cyproterone acetate. By blocking the effects of testosterone, these medications help feminize the body and prevent the development of masculine features.
Adverse Effects of Gender-Affirming Hormone Therapy:
Cardiovascular Risks: Studies have shown that transgender women receiving estrogen therapy may have an increased risk of cardiovascular events such as blood clots, deep vein thrombosis, and stroke. It is essential for healthcare providers to assess individual risk factors, such as smoking, obesity, and personal or family history of cardiovascular disease before initiating hormone therapy.
Thromboembolism: Estrogen therapy has been associated with an increased risk of venous thromboembolism (VTE). Patients should be educated about the signs and symptoms of VTE, such as leg swelling, pain, or shortness of breath, and advised to seek medical attention promptly if these symptoms arise.
Liver Function: Estrogen therapy can affect liver function, leading to alterations in liver enzymes. Regular monitoring of liver function tests is necessary to ensure patient safety.
Mood Changes: Some individuals may experience mood changes or emotional lability during hormone therapy. It is crucial to have ongoing mental health support and counseling for transgender individuals to address any emotional challenges that may arise.
Conclusion:
Gender-affirming hormone therapy, including estrogen therapy, is an integral part of the transition process for transfeminine individuals. Medications such as estrogen and anti-androgens are commonly prescribed to induce feminizing effects and suppress testosterone production. However, it is vital to consider the potential adverse effects associated with hormone therapy, including cardiovascular risks, thromboembolism, liver function alterations, and mood changes. Regular monitoring and ongoing support from healthcare providers are essential to ensure the safe and effective use of gender-affirming hormone therapy.
References:
Wierckx K, Mueller S, Weyers S, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med. 2012;9(10):2641-2651.
Radix A, Sevelius J, Deutsch MB. Transgender women, hormonal therapy and HIV treatment: a comprehensive review of the literature and recommendations for best practices. J Int AIDS Soc. 2016;19(3 Suppl 2):20810.