Endocrine therapy in transsexuals

Transsexuals who want to undergo surgery for transition to their desired sex have to receive hormonal therapy. Estrogen causes physical changes including breast growth, feminine shape, restriction of penile erection, and decreased libido in male-to-female transsexuals. Androgens induce masculinization in female-to-male (FTM) transsexuals, including cessation of menses, increased facial and body hair growth, increased muscle mass, deepening of voice, clitoromegaly, and increased libido. Adverse effects of estrogen include thromboembolic disease, severe liver dysfunction, cardiovascular disease, macroprolactinoma, decrease in muscle mass and strength, and depression. Adverse effects of androgens include severe liver dysfunction, erythrocytosis, acne, male-pattern hair loss, and increased visceral fat. Adolescents with gender dysphoria are treated with puberty-delaying hormones such as gonado-tropin-releasing hormone agonists. After careful long-term observation of their experience as patients diagnosed with gender identity disorder, they are treated with cross-sex hormones. To evaluate development of physical changes and adverse outcomes in transsexuals, regular monitoring using laboratory test results and measurement of blood pressure and body weight is performed after the first 3 months of treatment and twice yearly thereafter.