Transgender men: Evaluation and management
- Vin Tangpricha, MD, PhD
Vin Tangpricha, MD, PhD
- Associate Professor
- Emory University School of Medicine
- Joshua D Safer, MD, FACP
Joshua D Safer, MD, FACP
- Associate Professor of Medicine and Molecular Medicine
- Boston University School of Medicine
- Section Editors
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Alvin M Matsumoto, MD
Alvin M Matsumoto, MD
- Section Editor — Male Reproductive Endocrinology
- Professor of Medicine
- University of Washington School of Medicine
The terms transgender and gender incongruence describe a situation where an individual's gender identity differs from external sexual anatomy at birth. Health care providers should be familiar with commonly used terms (table 1). Gender identity-affirming care, for those who desire, can include hormone therapy and affirming surgeries as well as other procedures such as hair removal or speech therapy .
This topic will use the term transgender in the broadest sense to include any person with incongruence between gender identity and external sexual anatomy at birth. The evaluation and management of transgender men are discussed here. The evaluation and management of transgender women, the primary care of the transgender adult, and gender nonconformity in children and adolescents are reviewed separately. (See "Primary care of transgender individuals" and "Overview of gender development and clinical presentation of gender nonconformity in children and adolescents" and "Overview of the management of gender nonconformity in children and adolescents".)
STANDARDS OF CARE
Several large medical professional organizations have issued guidelines to assist providers in the care of transgender individuals (the World Professional Association for Transgender Health [WPATH] , the Endocrine Society , the American Congress of Obstetricians and Gynecologists [ACOG] ).
The following considerations are similar for transgender men and women and are discussed in detail in the topic on transgender women.
●Epidemiology (see "Transgender women: Evaluation and management", section on 'Epidemiology')
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- http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Health-Care-for-Transgender-Individuals (Accessed on August 03, 2016).
- World Professional Association for Transgender Health. Standards of care for gender identity disorders. http://wpath.org/publications_standards.cfm (Accessed on September 13, 2011).
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- STANDARDS OF CARE
- EVALUATION AND DIAGNOSIS
- Diagnostic criteria
- Gender dysphoria
- HORMONAL THERAPY
- Transgender men (female-to-male, FTM)
- - Goals
- - Criteria for starting
- - Androgen therapy
- Masculinizing effects
- Routine monitoring
- Adverse events
- - Persistent bleeding
- - Metabolic
- - Heart disease
- Fertility considerations
- GENDER CONFIRMATION SURGERY
- Sexual function after gender confirmation surgery
- Regrets after gender confirmation surgery
- PSYCHOSOCIAL OUTCOMES OF TREATMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS