Shireen is a 21-year-old transgender female who has been through an exhaustive counseling program
Hormonal therapy is the most effective method of transitioning from male to female. This can be achieved with estrogen, progesterone, and testosterone-blocking agents. There are many risks and benefits to the use of hormonal therapy that must be discussed prior to initiating treatment. These include but are not limited to adverse reaction to the medications and their dosage adjustment, increased risk of cancer or heart disease during or after treatment, decreased libido, and infertility issues later in life.
Hormonal therapy is a cornerstone of treatment for transgender patients, enabling them to continue the process of affirming their true gender identity. The hormones required for a regimen include estrogen, progesterone, and testosterone-blocking agents. Transgender female individuals have a physiologic need for these hormones and will have serious health consequences if denied them.
Hormonal therapy involves the use of estrogen, progesterone, and testosterone-blocking agents. Many patients have experienced mood swings, bloating, weight gain, breast tenderness, and changes in sexual interest and ability. Urethral strictures and urinary tract infections may occur if the patient is not monitored while on hormonal therapy.
Hormonal therapy gives many transgender individuals who have been through the counseling and therapy process more physical and psychological comfort, by causing them to feel more like their identified gender. In addition, hormone therapy helps prevent the development of testes in genetic males and breasts in genetic females. However, hormonal therapy can also have negative consequences, such as excessive bleeding, blood clots, high or low estrogen levels, weight gain or loss, increased bone turnover, elevated triglyceride levels, liver dysfunction, high blood pressure and diabetes. It is required that you be monitored while on hormonal therapy to check your health regularly.
Estrogen can be given via oral, transdermal, or injectable routes. Benefits may include increased breast growth and menses, decreased body hair and fat redistribution, reduced muscle mass, possible bone mineral loss and vaginal dryness. Estrogen also increases the risk of venous thromboembolic disease and stroke. Progesterone must be given on a cyclic basis. Its benefits include prevention of endometrial hyperplasia and endometrial cancer, maintenance of normal bones (i.e., decreasing the resorption of calcium from bone), prevention of menstrual cramping during menses, and regulation of menstrual cycle. The risks include increased risk of endometrial cancer. Testosterone-blocking agents are usually given as gonadotropin-releasing hormone agonists or GnRH-antagonists (GnRHas). Because these agents are usually given in combination with estrogen therapy to protect the breast from developing cancer cells, the patient will likely experience similar side effects from estrogen administration. Common side effects associated with GnRHas include weight gain and edema in the extremities.
Congratulations on deciding to begin hormone therapy! I see that you are on the transgender spectrum, which means that you identify with a gender different than the one which you were assigned as an infant. This program we are embarking on together will help make your physical body more consistent with your gender identity. As we move through this program together, make sure that you wear a barrier contraceptive during intercourse because both estrogen and progesterone can be passed through sexual fluid and lead to pregnancy. There are additional risks and side effects from hormone therapy, and I have listed some here for you. In addition, it is important that you have regular check-ups to monitor your heart rate, cholesterol levels, blood pressure, and weight. You should also maintain a birth control method as well as routine preventive care such as annual pap smears, breast exams, and other cancer screenings because these risk factors will increase when taking hormones: your baseline risks will change but will remain within what is considered normal for someone of your gender identity.
Shireen, I want to discuss with you what the risks are associated with hormone therapy. You see, there is an elevated risk for breast cancer when taking estrogen, and in order to monitor for breast cancer as well as other issues such as your increased chance of bleeding or blood clots in the legs and lungs you will need to undergo monthly breast exams.
This may be the most important decision your family will make for you. Although you seem certain about your gender identity, it is important to openly discuss any concerns that your parents have. Fortunately, hormone therapy is a safe treatment for gender dysphoria and will allow you to develop secondary sex characteristics of the gender with which you identify.
With HRT, it is important to monitor your blood regularly to watch for signs of hormone-related cancers and blood clots. There may be a slight increase in your risk for breast cancer at the beginning of hormone therapy. You also should undergo regular pap smears to monitor for cervical cancer as well as pelvic exams to monitor for ovarian cancer. These risks are higher in postmenopausal women, so consider whether you have any risk factors that would increase your risk even more.
Progesterone, a hormone that is required for the development of female secondary sex characteristics and plays an important role in pregnancy. It is derived from the ovaries, adrenal glands, and the synthetic form, progestins. Most women, who are taking this medicine as part of hormone replacement therapy, take small daily doses or patches applied to their skin.
There are many benefits to Hormone Replacement Therapy (HRT). Of primary concern is the reduction in your risk of breast cancer. By taking estrogen blockers with your hormone therapy you are ensured that there will be no development of breast tissue. Other benefits include increased energy, relief from mood swings and headaches, and a more even skin tone.
Shireen is a 21-year-old transgender female who has been through an exhaustive counseling program and is ready to start hormone therapy with estrogen, progesterone, and testosterone-blocking agents. When counseling her specifically about the risks, benefits, and required monitoring of hormonal therapy, the PMHNP advises Shireen that: