Emeritus VU Medical Center, Amsterdam, The Netherlands; Androconsult, Chiang Mai, Thailand.
J Sex Med. 2014 Aug;11(8):2012-9. doi: 10.1111/jsm.12563. Epub 2014 Apr 29.
Guidelines for cross-sex hormone treatment of transsexual people are now in place. However, little attention has been paid to the issue of treatment suitability for older people. Does existing treatment need to be adapted as subjects age, and does it make a difference if treatment is only started when the subject is already older?
To assess the necessity of adapting cross-sex hormone administration for elderly transsexual people.
Risks/benefits of continued use of cross-sex hormones with regard to bone health, cardiovascular risks, and malignancies.
Due to lack of data on the subject population, sex hormone treatment of other conditions in older non-transsexual people has been taken as the best available analogy to determine the extent to which these might be applicable to comparable transsexual persons. Findings in transsexual people receiving cross-sex hormone treatment sometimes modified the above approach of applying guidelines for the elderly to the aging transsexual population.
Testosterone administration to female-to-male transsexual persons (FtoM) carries little risk with regard to cardiovascular disease and cancer. For those with high hematocrit or cardiac insufficiency the dose can be reduced. Administration of estrogens to male-to-female transsexual persons (MtoF), particularly when combined with progestins, does significantly increase the risk of developing cardiovascular disease (almost a twofold incidence compared with the general population). This may require dose adjustment or changing from oral to safer transdermal estrogens. Tumors of the breasts, prostate and pituitary may occur. In FtoM, breast cancer can occur even after breast ablation. Older subjects can commence cross-sex hormone treatment without disproportionate risks.
Cross-sex hormones may be continued into old age but monitoring for cardiovascular disease and malignancies, both of the old and new sex, is recommended. MtoF will have more health complications in old age than FtoM requiring adaptations of treatment.
跨性别者的跨性别激素治疗指南现已出台。然而，人们很少关注老年人治疗的适宜性问题。随着年龄的增长，现有的治疗方法是否需要调整？如果只是在受试者已经年老时才开始治疗，这会有区别吗？
评估是否需要调整老年跨性别者的跨性别激素治疗。
继续使用跨性别激素对骨骼健康、心血管风险和恶性肿瘤的风险/益处。
由于缺乏该人群的数据，我们将其他情况下老年非跨性别者的性激素治疗作为最佳可用类比，以确定这些类比在多大程度上适用于可比的跨性别者。接受跨性别激素治疗的跨性别者的发现有时会修改上述方法，即将老年人群的指南应用于衰老的跨性别人群。
给予女性到男性跨性别者（FtoM）的睾丸激素治疗，在心血管疾病和癌症方面风险较小。对于那些血细胞比容高或心功能不全的人，可以减少剂量。给予男性到女性跨性别者（MtoF）的雌激素治疗，特别是与孕激素联合使用时，会显著增加患心血管疾病的风险（与一般人群相比发病率几乎增加一倍）。这可能需要调整剂量或从口服改为更安全的经皮雌激素。乳房、前列腺和垂体的肿瘤可能发生。在 FtoM 中，即使乳房已经切除，也可能发生乳腺癌。老年患者可以开始接受跨性别激素治疗，而不会有不成比例的风险。
跨性别激素治疗可延续至老年，但建议监测新老性别的心血管疾病和恶性肿瘤。与 FtoM 相比，MtoF 在老年时会出现更多的健康并发症，需要调整治疗方法。
