Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium.
Endocr Rev. 2019 Feb 1;40(1):97-117. doi: 10.1210/er.2018-00011.
Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair. Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population.
跨性别者的性别肯定治疗需要多学科方法，其中内分泌学家发挥着关键作用。本文旨在回顾最近关于该人群激素治疗及其对身体、心理和心理健康影响的数据。《内分泌学会跨性别女性指南》包括雌激素与降低雄激素药物联合使用。雌激素和抗雄激素的女性化治疗可带来理想的身体变化，如乳房增大、面部和身体毛发减少以及女性模式的脂肪重新分布。应与患者讨论可能的副作用，特别是有静脉血栓栓塞风险的患者。《内分泌学会跨性别男性指南》包括雄激素治疗，以使声音变深、停经、肌肉量增加、面部和身体毛发增加，从而实现男性化。由于缺乏证据，应个体化治疗性别非二元人群。年轻人可能会接受促性腺激素释放激素类似物的青春期抑制，随后再使用性激素。在进行任何激素干预之前，应讨论生育力保存的选择。跨性别男性的交叉性激素相关发病率和心血管风险保持不变，跨性别女性的情况尚不清楚。性甾体相关恶性肿瘤可能发生，但罕见。据发现，激素治疗后抑郁和焦虑等心理健康问题大大减少。未来的研究应旨在探索跨性别者激素治疗的长期结果，并提供证据表明性别肯定治疗对非二元人群的影响。
