Transgender women: Evaluation and management
- Vin Tangpricha, MD, PhD
Vin Tangpricha, MD, PhD
- Professor of Medicine
- 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 women are discussed here. The evaluation and management of transgender men, the primary care of the transgender adult, and gender nonconformity in children and adolescents are reviewed separately. (See "Transgender men: Evaluation and management" and "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 Endocrine Society has released updated guidelines for the treatment of gender dysphoria/gender incongruence . The new guidelines replace the term "transsexual" with "gender dysphoria" or "gender incongruence" and specify detailed professional qualifications for clinicians who diagnose, assess, or treat individuals with gender dysphoria/gender incongruence. Specifically, they now suggest that decisions regarding social transition for prepubertal youth be made in conjunction with a mental health or similarly experienced professional. They continue to recommend the management and monitoring of transgender adolescents, and adult men and women by a multidisciplinary team, as well as counseling patients about the time course of hormone-induced physical changes and options for fertility preservation. We agree with the updated guidelines.
Prevalence — Previous research had suggested that 0.3 to 0.5 percent of the adult population was transgender [5,6]. The prevalence of transgender depends upon the definition used to classify a person as transgender. In studies that included only individuals who had undergone hormone therapy, gender-affirming surgery, or had diagnostic codes documenting transgender, the reported prevalence of transgender was 7 to 9 per 100,000 people . However, studies that include transgender status based upon self-report indicate a prevalence of transgender of approximately 871 per 100,000 people . One study estimated that there are approximately 25 million transgender individuals worldwide .
Subscribers log in hereLiterature review current through: Nov 2017. | This topic last updated: May 16, 2017.References
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- STANDARDS OF CARE
- INITIAL PRESENTATION
- Psychiatric conditions
- OVERVIEW OF APPROACH
- Initial assessment
- Counseling before treatment
- Individualized approach
- Hormone therapy goals
- Criteria for starting treatments
- EVALUATION AND DIAGNOSIS
- Diagnostic criteria
- Gender dysphoria
- HORMONAL THERAPY
- Transgender women (male-to-female, MTF)
- - Suppression of androgen secretion or action
- GnRH agonists
- - Estrogen
- - Clinical outcomes
- - Monitoring
- - Long-term maintenance therapy
- - Major adverse events
- Cautions when using estrogen therapy
- 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