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 "Gender development and clinical presentation of gender nonconformity in children and adolescents" and "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')
- Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend 2012; 13:165.
- Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94:3132.
- 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).
- American Psychiatric Association. Gender dysphoria. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.451.
- Gooren L. Hormone treatment of the adult transsexual patient. Horm Res 2005; 64 Suppl 2:31.
- Becerra Fernández A, de Luis Román DA, Piédrola Maroto G. [Morbidity in transsexual patients with cross-gender hormone self-treatment]. Med Clin (Barc) 1999; 113:484.
- Olson J, Schrager SM, Clark LF, et al. Subcutaneous Testosterone: An Effective Delivery Mechanism for Masculinizing Young Transgender Men. LGBT Health 2014; 1:165.
- Dobs AS, McGettigan J, Norwood P, et al. A novel testosterone 2% gel for the treatment of hypogonadal males. J Androl 2012; 33:601.
- Giltay EJ, Gooren LJ. Effects of sex steroid deprivation/administration on hair growth and skin sebum production in transsexual males and females. J Clin Endocrinol Metab 2000; 85:2913.
- Wierckx K, Van de Peer F, Verhaeghe E, et al. Short- and long-term clinical skin effects of testosterone treatment in trans men. J Sex Med 2014; 11:222.
- Gooren LJ, Giltay EJ. Review of studies of androgen treatment of female-to-male transsexuals: effects and risks of administration of androgens to females. J Sex Med 2008; 5:765.
- Cosyns M, Van Borsel J, Wierckx K, et al. Voice in female-to-male transsexual persons after long-term androgen therapy. Laryngoscope 2014; 124:1409.
- Lapauw B, Taes Y, Simoens S, et al. Body composition, volumetric and areal bone parameters in male-to-female transsexual persons. Bone 2008; 43:1016.
- Gooren LJ, Giltay EJ, Bunck MC. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab 2008; 93:19.
- Mueller A, Kiesewetter F, Binder H, et al. Long-term administration of testosterone undecanoate every 3 months for testosterone supplementation in female-to-male transsexuals. J Clin Endocrinol Metab 2007; 92:3470.
- Wierckx K, Elaut E, Van Caenegem E, et al. Sexual desire in female-to-male transsexual persons: exploration of the role of testosterone administration. Eur J Endocrinol 2011; 165:331.
- Costantino A, Cerpolini S, Alvisi S, et al. A prospective study on sexual function and mood in female-to-male transsexuals during testosterone administration and after sex reassignment surgery. J Sex Marital Ther 2013; 39:321.
- Slagter MH, Gooren LJ, Scorilas A, et al. Effects of long-term androgen administration on breast tissue of female-to-male transsexuals. J Histochem Cytochem 2006; 54:905.
- Perrone AM, Cerpolini S, Maria Salfi NC, et al. Effect of long-term testosterone administration on the endometrium of female-to-male (FtM) transsexuals. J Sex Med 2009; 6:3193.
- van Kesteren P, Lips P, Gooren LJ, et al. Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones. Clin Endocrinol (Oxf) 1998; 48:347.
- Van Caenegem E, Wierckx K, Taes Y, et al. Bone mass, bone geometry, and body composition in female-to-male transsexual persons after long-term cross-sex hormonal therapy. J Clin Endocrinol Metab 2012; 97:2503.
- Gooren LJ, van Trotsenburg MA, Giltay EJ, van Diest PJ. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med 2013; 10:3129.
- Weinand JD, Safer JD. Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals. J Clin Transl Endocrinol 2015; 2:55.
- Moore E, Wisniewski A, Dobs A. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects. J Clin Endocrinol Metab 2003; 88:3467.
- Elbers JM, Giltay EJ, Teerlink T, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol (Oxf) 2003; 58:562.
- Elamin MB, Garcia MZ, Murad MH, et al. Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses. Clin Endocrinol (Oxf) 2010; 72:1.
- De Sutter P. Gender reassignment and assisted reproduction: present and future reproductive options for transsexual people. Hum Reprod 2001; 16:612.
- Wierckx K, Van Caenegem E, Pennings G, et al. Reproductive wish in transsexual men. Hum Reprod 2012; 27:483.
- Monstrey SJ, Ceulemans P, Hoebeke P. Sex Reassignment Surgery in the Female-to-Male Transsexual. Semin Plast Surg 2011; 25:229.
- Hage JJ. Metaidoioplasty: an alternative phalloplasty technique in transsexuals. Plast Reconstr Surg 1996; 97:161.
- Green R. Sexual functioning in post-operative transsexuals: male-to-female and female-to-male. Int J Impot Res 1998; 10 Suppl 1:S22.
- Murad MH, Elamin MB, Garcia MZ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf) 2010; 72:214.
- Klein C, Gorzalka BB. Sexual functioning in transsexuals following hormone therapy and genital surgery: a review. J Sex Med 2009; 6:2922.
- Wierckx K, Van Caenegem E, Elaut E, et al. Quality of life and sexual health after sex reassignment surgery in transsexual men. J Sex Med 2011; 8:3379.
- Wierckx K, Elaut E, Van Hoorde B, et al. Sexual desire in trans persons: associations with sex reassignment treatment. J Sex Med 2014; 11:107.
- Weyers S, Elaut E, De Sutter P, et al. Long-term assessment of the physical, mental, and sexual health among transsexual women. J Sex Med 2009; 6:752.
- Fisher AD, Castellini G, Ristori J, et al. Cross-Sex Hormone Treatment and Psychobiological Changes in Transsexual Persons: Two-Year Follow-Up Data. J Clin Endocrinol Metab 2016; 101:4260.
- 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