Transgender Health Care

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Services include Hormone therapy for transgender patients. Hormones and anti -androgen medications are prescribed. Bio-identical hormones in various forms are available as well as conventional hormone prescriptions.

Naturopathic medicine can address health risks and medication side effects that can occur with hormone therapy. For example, testosterone can adversely affect cholesterol and lipid levels. There are effective naturopathic treatments in addition to diet and exercise counseling that can be used to reduce the cardiovascular risks associated with unhealthy lipid levels.

Each transgender person’s goals and expectations for transitioning are as individual as they are. The transition can be with or without hormone therapy and/or surgery. Hormone therapy is generally continued life long, although doses may be reduced over time or post surgery.

Kink, poly and all sexualities and genders welcome.

Click on one of these selections for more information:

 


Feminizing hormone regimens

Changes occur slowly and may be less than desired.
Body/bone size and structure, facial hair growth patterns will not change. Beard hair will be less thick but will remain.
Electrolysis and laser hair removal are helpful, but can be costly and require multiple treatment sessions.
Voice pitch will not change, but more typically feminine vocal patterns can be taught.
Most changes are reversible, except breast enlargement.

Feminizing Hormone Therapy

  • Estrogens can be taken as pills, patches or injections.
  • Dose may be reduced after orchiectomy surgery or after maximum feminization is reached.
  • Doses are 4 to 8 times the HRT dose for menopausal women. Patch reduces risk for blood clots.
  • Must be stopped for 2 weeks prior to surgery due to risk of blood clots.
  • Anti-androgen: usually spironolactone (a diuretic with testosterone reducing and receptor blocking effects). Finasteride may also be used to block DHT (a form of testosterone)
  • Progesterone may be added later.

 

Expected Desirable Effects:

  • breast development- a size B cup is usually maximum, and will take at least 2 years to reach.
  • redistribution of body fat, increasing in hips, thighs and buttocks and less in abdomen.
  • softening of skin
  • suppression of testosterone production, decreased size of testes and possible penis, with less frequent and weaker erections
  • less muscle mass in upper body (and strength)
  • torso and extremity hair will lessen over several years, but areola, armpit and pubic hair change less.
  • slowed or reversed loss of scalp hair

 

Possible or Theoretical Desirable Effects:

  • decreased heart disease risks, improved lipid profile
  • improved mood and impulse control
  • decreased benign prostatic hypertrophy

 

Adverse Effects:

  • blood clots (venous thrombosis) in legs, lungs, other areas. Pulmonary embolism, heart attack and stroke may be fatal.
  • thrombophlebitis
  • hypertension, prolactinoma,diabetes, nausea/vomiting, migraine headache, decreased libido, impotence, gallbladder disease, abnormal liver or kidney function tests, mood disorder/depression, melasma (skin darkening in spots), low sodium, elevated triglycerides, elevated potassium

 

Possible or Theoretical Adverse Effects:

  • increased risk of breast cancer, hepatitis, heart attack, stroke, other cancers, infertility (possibly permanent)
  • Consider sperm banking, if appropriate

Based on the risk of adverse effects, there are some corresponding precautions and contraindications for hormone therapy.

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Masculinizing hormone regimens

Changes occur quickly, within a few months, and most are permanent.

Masculinizing hormone therapy

  • Testosterone: by self-injection every one to two weeks, patch or topical cream or gel.
  • Dose may be reduced after oophorectomy, must must be maintained for osteoporosis prevention and masculinization effects.

Expected desirable effects

  • cessation of menses
  • lowered voice range (permanent)
  • increased hair growth on face, chest, extremities (permanent)
  • increased upper body muscle mass and strength
  • increased weight
  • clitoral enlargement (permanent)
  • redistribution of body fat from hips to abdomen
  • mild breast atrophy

Possible or theoretical desirable effects

  • decreased risk of osteoporosis
  • increased libido, interest and arousability
  • increased physical energy

Adverse effects

  • abdominal (apple shaped) obesity
  • peripheral edema
  • acne
  • erythrocytosis, abnormal liver tests
  • worsening of cholesterol profile, increased risk of cardiovascular disease
  • headache
  • coarsening of skin
  • emotional lability, increased anger and aggression
  • male pattern baldness (permanent)
  • infertility (may be permanent)

Possible or theoretical risks

  • increased risk of breast cancer
  • hypertension
  • polycystic ovaries, ovarian cancer

Based on these risks, there are corresponding precautions and contraindications for hormone therapy.
Reproductive counseling regarding loss of fertility should be included in informed consent.

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Thanks to the Tom Waddell Health Center Transgender Team in San Francisco for their protocol information.