Surgery For Trans Men
Common chest procedures for trans men include:
- removal of both breasts and associated chest reconstruction
- nipple repositioning
Breast implants for trans women are not routinely available on the NHS.
Gender surgery for trans men includes:
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Feminizing Testosterone Blockers For Transgender Women
While many transgender patients immediately think of estrogen therapy, the primary predictor of feminizing effects is actually the lack of testosterone rather than increased levels of estrogen.
Testosterone blockers also known as anti-androgens can reduce the male sex hormones that cause male or masculine features. There are a number of medications that your provider can prescribe to block testosterone.
Spironolactone is the most common anti-androgen medicine used feminizing hormone therapy. Spironolactone works by blocking the production and the actions of testosterone. While spironolactone is widely used, safe and well tolerated by most women, it can have side effects for some people. Excessive urination, dizziness, and very rarely elevated potassium levels can occur. Your physician will monitor your blood testosterone level while taking spironolactone to help ensure that proper levels are being achieved.
If spironolactone is not appropriate or well tolerated, gonadotropin-releasing hormone analogs , may be used. This therapy causes the pituitary gland to shut down the signals being sent to your testicles that tell them to make testosterone. Spironolactone can be very effective and well tolerated, but can be expensive, and not all insurance plans cover it.
What Are The Risks And Benefits Of Vaginoplasty For Gender Affirmation
One of the main benefits is relief from gender dysphoria. After surgery, individuals achieve better consistency with the gender they identify with. This has enormous benefits on peoples mental health and improves their quality of life.
Risks of vaginoplasty for gender affirmation can include:
- Vaginal stenosis.
- Vesicovaginal fistula or rectovaginal fistula .
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What Happens During Transgender Surgery
What happens during surgery varies depending on the procedure. You may choose facial surgery, top surgery, bottom surgery or a combination of these operations.
Facial surgery may change your:
- Cheekbones: Many transgender women have injections to enhance the cheekbones.
- Chin: You may opt to soften or more prominently define your chins angles.
- Jaw: A surgeon may shave down your jawbone or use fillers to enhance your jaw.
- Nose: You may have a rhinoplasty, surgery to reshape the nose.
If you are a transgender woman , other surgeries may include:
- Adams apple reduction.
- Placement of breast implants .
If you are a transgender man , you may have surgeries that involve:
- Removal of the ovaries and uterus .
When Should I See My Healthcare Provider
After surgery, you should see your healthcare provider if you experience:
- Bleeding for more than a few days after surgery.
- Pain that doesnt go away after several weeks.
- Signs of infection, such as a wound that changes color or doesnt heal.
A note from Cleveland Clinic
Gender affirmation procedures help people transition to their self-identified gender. Gender affirmation surgery may involve operations to change the face, chest or genitalia. You may choose to have one type of surgery or a combination of procedures. Before and after surgery, its important to work with a mental health provider. Research shows that having a trusted therapist makes you more likely to be satisfied with your surgery results.
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Emotional Effects Of Hormone Therapy On Transgender People
The emotional effects of masculine and feminine transitioning hormone therapy are similar. Changes in hormone levels can affect your moods and feelings both, positively as well as negatively. However, during hormone therapy in transgender people, it gets difficult to tell which mood variations are because of chemical change and which are because of other factors. For example, happiness could result from bringing the body more in line with the mind.
Study Selection Quality Assessment And Data Extraction
Each study was initially categorised based on its design and examined for quality in line with the Effective Public Health Practise Project tool. This is a generic tool used to evaluate a variety of intervention study designs and is suitable for use in systematic reviews, having content and construct validity. Based on the EPHPP, six domains are evaluated: selection bias study design confounders blinding data collection method and withdrawals/dropouts. Each domain is rated as strong , moderate or weak , and domain scores are averaged to provide the overall mean rating. Based on the overall mean rating, studies are rated as weak , moderate or strong .
For longitudinal studies, data were extracted to examine changes in LBM, CSA, strength and Hgb/HCT in transwomen taking GAHT. In cross-sectional studies, data in transwomen were compared with data from both cisgender men and cisgender women. The study authors were contacted if there were any questions regarding the presented data. In this regard, authors of the nine studies carried out by the European Network for the Investigation of Gender Incongruence were contacted regarding potential overlapping participants and another author was contacted to clarify graphical data content.
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Nbc Outstruggle For Transgender Rights Shifts To Health Care
A traditional study to determine direct cause and effect usually involves one group receiving a placebo, while the other group takes the real medicine. But giving a patient in transition fake hormones without his or her knowledge or consent is ethically prohibitive.
For now, this study is the best measure we have of the risk, and its much better than what weve had before, Getahun said.
In the past, studies measuring cardiovascular effects of estrogen therapy have been done on menopausal women and applied to transgender women. But the study of transgender women found significant differences, particularly for long-term use. Menopausal studies cited by the Kaiser researchers showed risks of cardiovascular illness declining over long-term use, but the Kaiser study found that risk increased for transgender women over time.
Still, Dr. Joshua Safer, another author of the study and executive director of the Transgender Medicine Center at Mount Sinai Hospital in New York, said that while the cardiovascular risk is higher for transgender women, its not that high. There were 148 cardiovascular events recorded out of the 2,842 transgender women in the eight-year period.
The confirmation of this risk is good to have so patients can be warned and precautions can be taken, he said in an interview. But I think most transgender women would conclude the risk is not high enough to forgo hormone therapy.
Is Gender Affirmation Surgery The Only Treatment For Gender Dysphoria
No. Surgery is just one option. Not everyone who is transgender or nonbinary chooses to have surgery. Depending on your age and preferences, you may choose:
- Hormone therapy to increase masculine or feminine characteristics, such as your amount of body hair or vocal tone.
- Puberty blockers to prevent you from going through puberty.
- Voice therapy to adjust your voice or tone or help with communication skills, such as introducing yourself with your pronouns.
People may also socially transition to their true gender with or without surgery. As part of social transitioning, you might:
- Adopt a new name.
- Present as your gender identity by wearing different clothing or changing your hairstyle.
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Hormone Replacement Therapy For Men
Testosterone is a hormone produced by the testicles that are responsible for mens health. When a person gets older, they experience hormone deficiency that affects many body functions. Men suffer from erectile dysfunction, loss of muscular strength and bone density, depression, and many other symptoms. We aim at helping every person live a full life with testosterone replacement therapy.
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Contraindications And Reservations For E2 Treatment In Transgender Women
Long-term risks regarding cardiovascular health and cancer should be discussed with the patient before initiating E2 treatment . Clinical and laboratory workup at baseline should assess BMI, blood pressure, lipid profile, and HbA1c. BMI and smoking are important modifiable risk factors for cardiovascular disease and several cancer types. Obesity and smoking could be considered relative contraindications for GAHT, but cut-off levels for BMI are not available. Of course, lifestyle intervention is considered part of good clinical practice if needed. In these patients, the preferred use of dermal E2 above the age of 40 years is discussed previously. But, overall, feminizing treatment can be considered safe, and prospective metabolic risk screening can follow current guidelines for cisgender persons .
Feminizing treatment. Balance between desired effects and potential side effects and a list of most important risk factors .
Citation: European Journal of Endocrinology 185, 2 10.1530/EJE-21-0059
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What Are The Risks Of Hormone Treatment
Ideally, medical treatment should be based on scientific evidence, but there is little research about the use of cross-sex hormones. Guidance is therefore provided, which may be used flexibly, taking account of your particular needs and keeping the risk to your health as low as possible.
Hormone treatment for trans people at reasonable dosages is remarkably safe. The hormone products that you will be prescribed are very like the natural hormones produced by the body. Most people taking hormones do not experience any major problems.
However, all medication has potential side effects, and some people may have serious adverse reactions to it. You need to be aware of the possible risks, however remote, before deciding to start treatment.
The most serious risks when taking oestrogens are:
Thrombosis Pulmonary embolism Altered liver function.
The most serious risk when taking testosterone is:
Polycythaemia .The risk of developing complications from hormone treatment is relatively small and is less common if your general health is good.Thrombosis in trans women is more likely to occur within the first year of treatment, particularly if you are taking a hormone called ethinylestradiol.There are far fewer risks of thrombosis with oestradiol, which is the product most widely prescribed for trans women now.
Practical Guidelines For Transgender Hormone Treatment
Adapted from: Gardner, Ivy and Safer, Joshua D. 2013 Progress on the road to better medical care for transgender patients. Current Opinion in Endocrinology, Diabetes and Obesity 20: 553-558.
KEY POINTS
- In order to improve transgender individuals access to health care, the approach to transgender medicine needs to be generalized and accessible to physicians in multiple specialties.
- A practical target for hormone therapy for transgender men is to increase testosterone levels to the normal male physiological range by administering testosterone.
- A practical target for hormone therapy for transgender women is to decrease testosterone levels to the normal female range without supra- physiological levels of estradiol by administering an antiandrogen and estrogen.
- Transgender adolescents usually have stable gender identities and can be given GnRH analogs to suppress puberty until they can proceed with hormone therapy as early as age 16.
Hormone regimes for transgender men
1. Oral
2. Parenterally
- Testosterone enanthate or cypionate 50200mg/week or 100200mg/2 weeks
- Testosterone undecanoate 1000 mg/12 weeks
3. Transdermal
- Testosterone 1% gel 2.5 10 g/day
- Testosterone patch 2.5 7.5 mg/day
i.m., intramuscular.*Not available in the USA.
Monitoring for transgender men on hormone therapy:
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Masculinizing Hormone Therapy And Fertility
While some transgender men have sucessfully undergone egg freezing or IVF after starting hormone therapy, long-term use of hormones may lead to permanent infertility. If you want to leave open the possibility of starting a family by having children biologically, consult your doctor about your options for egg freezing before starting treatment.
Given that individual responses to testosterone treatment vary, you have a chance of becoming pregnant even while taking hormones. Your doctor can advise you about your options for birth control.
What Are The Steps Before I Can Be Prescribed Hormones To Transition To My Affirmed Gender
It usually takes two separate visits to the UI LGBTQ Clinic before you will be prescribed hormones.
During the first appointment, you will meet with one of the doctors and she will review your personal and family health history and perform an exam. You will also meet with the pharmacist who will review the medications commonly used. She will review the risks of the medications and common side effects as well as a timeline of expected changes. You will have baseline blood work done during this visit. If you recently had blood work done, please bring these results with you for the doctor to review.
We generally require people to have at least one evaluation from a mental health professional such as a therapist, counselor, or psychiatrist. The evaluation should focus on your gender history and ability to understand the risks and benefits of treatment used to transition to another gender. After the evaluation, the mental health professional will provide you with the necessary letter that you will share with the doctor. If you need help finding a therapist who has experience working with transgender and gender non-conforming people, we can help identify a mental health provider for you. While it is not required that you have ongoing appointments with the therapist, the doctor or therapist may recommend this.
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When Will These Physical Changes Occur
According to a , a person can expect a decrease in sexual desire and function within 13 months. However, these changes can take 36 years to reach their maximum effect.
After 36 months, a person can expect:
- a decrease in muscle mass
- alleviation of gender dysphoria
The UCSF state that a person may notice that they experience a wider range of emotions. They may also develop different tastes and interests. These emotional changes should settle.
During this time, some people might find it helpful to talk to a mental health professional to help explore and understand these new emotions and thoughts.
How Long Does Facial Feminization Surgery Last
If you get a comprehensive FFS as a single surgery, it can take eight to nine hours. Some surgeons recommend splitting the procedures into two surgeries, separated by seven to 10 days or longer. Doing two surgeries gives your face more time to heal between surgeries and allows more flexibility for patients.
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Physical Changes In Transgender Men
Menses discontinuation, clitoris enlargement, and lower-pitched voice are some of the changes aimed by transgender men . In addition, therapy will enhance a more masculine musculature, body shape with an increase in body weight, a decrease in body fat, and an increase in lean mass as well as grip strength . Testosterone therapy has been associated with increases in the Ferryman-Gallwey hirsutism scores. However, after 12 months, facial and abdominal hair do not reach diameters found in cisgender males. An increase in acne and alopecia is often observed as some of the side effects .
What Are The New Findings
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Longitudinal and cross-sectional studies identify that hormone therapy in transwomen decreases muscle cross-sectional area, lean body mass, strength and haemogloblin levels, with noted differences in the time course of change.
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Haemoglobin levels decrease to those seen in cisgender women after 4 months of hormone therapy. In contrast, despite significant decreases in muscle cross-sectional area, lean body mass and strength after 1236 months of hormone therapy, values remain higher than that in cisgender women.
-
It is possible that transwomen competing in sports may retain strength advantages over cisgender women, even after 3 years of hormone therapy.
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Study Finds Health Risks For Transgender Women On Hormone Therapy
Transgender women on hormone therapy may be at a higher risk for cardiovascular problems, such as stroke, blood clots and heart attack, researchers reported Monday.
The study was done by reviewing eight years of medical records of nearly 5,000 transgender patients in the Kaiser Health system, and looked at patients over the age of 18 who took hormones for gender transition. Over 97,000 cisgender patients people whose sex assigned at birth matches their gender identity with similar age and health characteristics were studied for comparison.
My concern is that doctors who are inclined to deny hormone therapy will use this study as a reason to do so.
This is the largest study of the health of transgender individuals on hormone therapy ever done, Dr. Darios Getahun, an author of the study and research scientist at Kaiser Permanente, told NBC News. Doctors and patients need to be aware of the possibility for increased health risks for transgender women.
The study found that transgender women, who are assigned the male sex at birth, were twice as likely as cisgender men or women to have the blood clot condition venous thromboembolism. Transgender women on hormone therapy were also found to be 80 to 90 percent more likely to have stroke or a heart attack than cisgender women.
Transgender men on hormone therapy, however, were not found to have a higher risk.
Metabolic Changes In Transgender Men
Lipid parameters are adversely modified by testosterone therapy in transgender men. A recent meta-analysis of the available data demonstrated no change in total cholesterol or LDL-c. Still, there was a minor increase in triglyceride and a decrease in plasma HDL-c levels, both of which are pro-atherogenic . Another meta-analysis showed a progressive change in lipid parameters over 24 months with higher triglycerides levels compared with baseline statistically significant serum LDL-c increase and HDL-c decrease were also observed, with no statistically significant differences in total serum cholesterol level . Testosterone therapy has no effect on fasting glucose, fasting insulin, or glucose utilization. However, transgender men were found to have decreased adiponectin, which is associated with insulin resistance and higher CV risk . Regarding blood pressure, the results of various studies are contradictory . Testosterone therapy increases plasma homocysteine levels in transgender men, which could have a negative impact on CV risk. After one year of hormonal treatment, transgender men presented increased homocysteine and leucocytes levels, with an increase in mean maximum carotid intimal media thickness .
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