Key Conclusions And Recommendations For Future Clinical Research
The current available research is based mostly on cross-sectional studies, with limited longitudinal data. There is also a paucity of information on diverse ethnic and socioeconomic populations and studies on treatment outcome in adolescents. The current literature comes from mostly Western European and from higher income countries, where many participants undergo surgical procedures, and has at best intermediate duration follow-up. Limited data exist on hormonal treatment in gender nonbinary persons. For specific analyses such as outcome or mortality, no single center has a sufficiently large patient base to study the population with statistical rigor.
Transgender medicine research is finally moving away from case reports and small series. Many efforts have gone into summarizing available data in numerous recent systematic reviews, from which we have to internalize the findings, avoid repeating the same research, and take the investigations further. The collection and reporting of original good quality data through networks has to be higher on the agenda. Innovative and patient-centered long-term research with randomized controlled trials if possible, to advance of the safety and efficacy of hormonal interventions, is a priority. In doing so, clinicians and academics must listen to the voices of transgender people, recognizing and respecting the internal diversity within the transgender community.
What Are The Types Of Hormone Therapy
There are two main types of hormone therapy :
- Estrogen Therapy: Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis.
- Estrogen Progesterone/Progestin Hormone Therapy : Also called combination therapy, this form of HT combines doses of estrogen and progesterone .
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How Do I Talk To My Doctor About Low Testosterone
It may not be easy to speak to a doctor about the need for testosterone therapy. It can be embarrassing to feel like less of a man, particularly because one of the first and most common signs of low-t is loss of sex drive, and/or erectile dysfunction. This is all the more reason why you should seek your testosterone treatments from a doctor who specializes in hormone replacement for men. As well as being better equipped to interpret all of your symptoms, he will be more conscious of the self-esteem issues that could also come along with low-T. Still when talking to any doctor about low-T, you must be confident enough to tell him or her all about your symptoms. Do not leave anything out because you believe it may not be important, or may be embarrassing. In the long run, doing so, will only keep you from getting the best testosterone therapy possible.
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Specialization In Hormone Health
Hormone imbalance and age-related hormone changes can have complex and far-reaching effects on the body. As such, identifying symptoms and creating effective strategies for addressing those symptoms require specialized expertise.
Many people are surprised to learn that no specialized training is required for a doctor to offer hormone health advice or prescribe HRT. Many practitioners are now interested in HRT, but it takes more than an interest to ensure hormonal needs are addressed correctly. Its important to connect with a practitioner who has undergone rigorous training in this unique area of medicine. The criteria below demonstrate the commitment and in-dept training required to try and obtain the best patient outcomes.
- Board certification or eligibility in a clinical field that requires patient contact
- Rigorous post graduate training in integrative and hormonal medicine
- Ongoing training in hormone therapy to keep up with the latest treatments, techniques, and technologies
- Active membership in professional societies, such as the American Academy of Anti-Aging Medicine
How Do You Treat The Symptoms Of Menopause
Since the symptoms of menopause can be very challenging to manage, treatment is often sought after. There are several options available including hormone replacement therapy , which means replacing estrogen in the body as natural levels decline. HRT can be given several different ways including as a pill, estrogen patch and vaginal estrogen preparations.
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Expert Treatment For Hormonal Disorders
Some hormone disorders, such as an underactive thyroid, can be treated with daily hormone medication. Other diseases may require more complex treatment, such as surgery. An endocrinologist can review treatment options and help you choose the best one for you.
Drugs and Injections
A number of drugs can help treat hormonal disorders.
- Glucocorticoid pills can replace hormones such as cortisol that may be low due to malfunctioning adrenal glands or pituitary gland.
- Several types of oral medicine or injectable insulin can be used to treat diabetes.
- Testosterone replacement in the form of topical gels or injections may work for men who have low testosterone.
An endocrinologist may also suggest thyroid surgery to remove a gland with a growth, or one so highly overactive or swollen it affects your breathing.
You may need surgery to remove the nearby parathyroid glands if they contain a growth. In some cases, surgeons remove parathyroid tissue because the tissue is highly overactive, leading to high calcium levels in the body.
Medical And Hormone Replacement Therapy For Endocrine Disorders
Endocrine disorders cause symptoms that may affect your mood, comfort and wellbeing. At Cedars-Sinai, any symptom impacting your daily life matters to us. Our renowned endocrinology experts are here to help you feel better.
We treat many problems using medications and hormone replacement therapy. And our focus on your needs helps you get the most out of treatment.
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How Is Thyroid Hormone Replacement Therapy Dosage Determined
Healthcare providers do careful blood testing to find the proper dose of hormone replacement therapy for each person. The blood tests reveal levels of thyroid hormones in the blood, as well as thyroid-stimulating hormone released by the pituitary gland. The pituitary gland plays an integral role in the functioning of the thyroid gland. It controls how much thyroid hormone is released by making TSH that “stimulates” the thyroid. Increased levels of TSH may indicate that you have an underactive thyroid or that thyroid hormone replacement needs to be increased.
You will have lab tests to measure levels of thyroid hormones and TSH. Hypothyroidism can be a progressive disease. This needs dosage increases over time.
To make sure that your thyroid hormone replacement works properly, consider the following recommendations:
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Maintain regular visits to your healthcare provider.
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Take your thyroid medicine at least 1 hour before breakfast and any calcium or iron medicines you may take. Or take at bedtime, or at least 3 hours after eating or taking any calcium or iron medicines.
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Tell your healthcare provider of your thyroid hormone treatment before beginning treatment for any other disease. Some treatments for other conditions or diseases can affect the dosage of thyroid hormone therapy.
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Let your healthcare provider know if you become pregnant.
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Tell your healthcare provider of any new symptoms that may arise.
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Tell all healthcare providers of your thyroid condition and medicine dosage.
Qualifications Of The Prescribing Provider
Prescribing gender affirming hormones is well within the scope of a range of medical providers, including primary care physicians, obstetricians-gynecologists, and endocrinologists, advanced practice nurses, and physician assistants. Depending on the practice setting and juris diction, other providers with prescriptive rights may also be appropriate to prescribe and manage this care. Most medications used in gender affirming hormone therapy are commonly used substances with which most prescribers are already familiar due to their use in the management of menopause, contraception, hirsutism, male pattern baldness, prostatism, or abnormal uterine bleeding.
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What Kind Of Doctor Provides Testosterone Therapy For Men
- The safest and most effective treatment for men diagnosed with low testosterone, is testosterone replacement therapy.
- You can only get authentic testosterone therapy with a doctors prescription.
- Any doctor can prescribe testosterone replacement, but for the most effective results, it is best to choose a doctor or clinic, that specializes in hormone replacement therapies.
If you are a man between the ages of 35 and 65, and are not feeling yourself lately, and if you find that you tire easily, cannot concentrate as you once could, are putting on weight and having a lot of trouble taking it off, and/or are having sexual performance issues, there is a good chance that you have low testosterone.
The safest and most effective way to treat low testosterone, also known a low-T, is with testosterone replacement therapy. The only way to know for sure if you would benefit from testosterone therapy is to have your testosterone levels checked by a doctor. Real testosterone therapy is only available with a doctors prescription.
The safest and most effective way to treat low testosterone, also known a low-T, is with testosterone replacement therapy. The only way to know for sure if you would benefit from testosterone therapy is to have your testosterone levels checked by a doctor.
Am I A Candidate For Bioidentical Hormone Replacement Therapy
The endocrinology team at Fort Wayne Endocrinology determines if youre a candidate for bioidentical hormone replacement therapy after a comprehensive examination. Your provider reviews your symptoms and medical history and checks your hormone levels.
Though your blood hormone levels provide valuable information about what’s happening in your body, the experts at Fort Wayne Endocrinology understand that your lab work may not truly reflect what’s happening with the hormones in your body.
You may be a candidate for bioidentical hormone replacement therapy if you’re struggling with symptoms related to hormone imbalances that occur in men and women as they get older.
Common symptoms you may experience with an imbalance in hormone levels include:
- Vaginal dryness in women
- Erectile dysfunction in men
The experts at Fort Wayne Endocrinology have advanced training in BHRT and can design a plan to ease your symptoms and improve your overall well-being.
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Benefits Of Hormone Replacement Therapy
For many healthy adults who are experiencing moderate or severe menopausal symptoms, there are benefits to using hormone replacement therapy that may override potential risks of this treatment.
Medical experts note that the benefits of HRT can include:
- Relief from moderate to severe hot flashes
- Relief from vaginal dryness and discomfort
- Prevention of bone loss and bone fractures
- Protection against colorectal cancer
In addition, the American College of Obstetrics and Gynecologists notes that otherwise healthy people who are experiencing early menopause or estrogen deficiency may find HRT beneficial.
Hormone replacement therapy is recommended on an individual basis. It’s important to speak with a healthcare provider about the potential benefits and risks of HRT based on factors like your symptoms, medical history, and overall health.
Enhancing Healthcare Team Outcomes
Patients undergoing menopause require management from an interprofessional team that also includes the pharmacist and nurse. To improve patient outcomes, clinicians should not empirically prescribe hormone replacement therapy. These hormones correlate with a variety of adverse effects, including an increased risk of breast cancer, stroke, heart disease, and deep vein thrombosis. The duration of treatment of these hormones should not be more than a few years, and close monitoring is required. If the female has mild symptoms of menopause, then education should be provided about the benefits and harm of these hormones. The pharmacist should consult with the prescriber on the exact agent and dosing, while also examining the patient’s medication record. Nursing needs to be very aware of signs of adverse events, and monitor closely on subsequent visits, alerting the clinician of any concerns. This interprofessional team approach will drive the best outcomes with HRT.
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Treatment For Pituitary Issues
If the cause of low testosterone stems from issues with the pituitary gland, it may be possible to restore fertility through the use of pituitary hormones. If the pituitary gland is simply underactive, the hormones would reinstate the pituitary-hypothalamus-testes feedback loop and revive sperm production.
If, however, the pituitary is disrupted as a result of a tumor, surgery, medication, or radiation treatment, a hormone replacement therapy may be required.
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What If You Have Low Testosterone
Having low testosterone levels in men is one of the most common reasons for hormone replacement therapy in men. These men may be having some of the symptoms experienced above especially low energy, loss of sexual interest, and erectile dysfunction. In addition to these there may also be a loss of hair, growth of breast tissue, loss of muscle mass, and increased moodiness.
Testosterone replacement therapy can be effective in those with low testosterone levels, especially associated with aging. Testosterone is also commonly taken with estrogen blockers and human chorionic gonadotropin to enhance the effects of treatment and reduce as many risks as possible.
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Is Hormone Replacement Therapy The Same For Everyone
You would not give the same amount of medicine to a child that you would to an adult, or to a 300 pound wrestler that you would to a 90 pound elderly woman. Hormone replacement therapy is no different.
Each therapeutic regimen is created specifically for that person based on their risk factors, age, symptoms, and results of the hormone lab tests. If your hormone levels are extremely low to begin with you will likely need a much higher dose to keep your hormone levels in a safe range. It takes a specially trained provider to take all of these factors into consideration and create the right treatment for you.
Adverse Outcome Prevention And Long
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4.1. We suggest regular clinical evaluation for physical changes and potential adverse changes in response to sex steroid hormones and laboratory monitoring of sex steroid hormone levels every 3 months during the first year of hormone therapy for transgender males and females and then once or twice yearly.
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4.2. We suggest periodically monitoring prolactin levels in transgender females treated with estrogens.
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4.3. We suggest that clinicians evaluate transgender persons treated with hormones for cardiovascular risk factors using fasting lipid profiles, diabetes screening, and/or other diagnostic tools.
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4.4. We recommend that clinicians obtain bone mineral density measurements when risk factors for osteoporosis exist, specifically in those who stop sex hormone therapy after gonadectomy.
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4.5. We suggest that transgender females with no known increased risk of breast cancer follow breast-screening guidelines recommended for non-transgender females.
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4.6. We suggest that transgender females treated with estrogens follow individualized screening according to personal risk for prostatic disease and prostate cancer.
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4.7. We advise that clinicians determine the medical necessity of including a total hysterectomy and oophorectomy as part of gender-affirming surgery.
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Biological Determinants Of Gender Identity Development
Ones self-awareness as male or female changes gradually during infant life and childhood. This process of cognitive and affective learning evolves with interactions with parents, peers, and environment. A fairly accurate timetable exists outlining the steps in this process . Normative psychological literature, however, does not address if and when gender identity becomes crystallized and what factors contribute to the development of a gender identity that is not congruent with the gender of rearing. Results of studies from a variety of biomedical disciplinesgenetic, endocrine, and neuroanatomicsupport the concept that gender identity and/or gender expression likely reflect a complex interplay of biological, environmental, and cultural factors .
Researchers have made similar observations regarding the potential role of androgens in the development of gender identity in other individuals with DSD. For example, a review of two groups of 46,XY persons, each with androgen synthesis deficiencies and female raised, reported transgender male gender role changes in 56% to 63% and 39% to 64% of patients, respectively . Also, in 46,XY female-raised individuals with cloacal exstrophy and penile agenesis, the occurrence of transgender male changes was significantly more prevalent than in the general population . However, the fact that a high percentage of individuals with the same conditions did not change gender suggests that cultural factors may play a role as well.
Risks Of Hormone Replacement Therapy
Many medical experts agree that hormone replacement therapy is an option worth considering for healthy adults under 60 seeking to manage certain menopausal symptoms. But it’s important to point out that research has highlighted several potentially serious risks of using HRT.
In particular, research that began in 2002 raised significant concerns, including that some participants on HRT had a higher risk of breast cancer, heart disease, stroke, blood clots, urinary incontinence, gallbladder disease, and dementia. The affected participants were mostly over the age of 60 and past the menopausal stage.
Since then, researchers have continued to analyze these findings as they explore the long-term safety of HRT. Experts have clarified that the potential risks may be more likely in people who:
- Begin HRT at age 60 or older
- Begin HRT more than 10 years after the start of menopause
- Have a personal or family history of conditions like cancer and heart disease
Anyone with these risk factors will not be considered a candidate for hormone replacement therapy.
To help avoid further risks in people who are prescribed HRT, the U.S. Food and Drug Administration recommends using HRT at the lowest working dose for the shortest period of time possible, which is typically no longer than five years.
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Symptoms Of Low Hormones
As mentioned before you may not always know that you have low hormone levels, but sometimes you do.
Some common symptoms to have when you have low hormone levels are feeling very tired or fatigued, having a difficult time sleeping, losing muscle mass, gaining body fat, and having a slow recovery from injuries or illness. Other symptoms of low hormones may be reduced libido, erectile dysfunction, foggy thinking, decreased motivation for life, joint and muscle pain, and depression or anxiety.
If you are experiencing one or more of these symptoms you should schedule a doctors appointment. Even if it could be something else, these symptoms are not normal and should be addressed.