Few changes in memory or cognition were observed, and changes that were observed were not consistent across study designs. An evaluation for testicular neoplasms should be performed with a scrotal exam as well as testing for elevated serum human chorianogonadotropin hCG , lactate dehydrogenase LDH , alpha-fetoprotein AFP levels, and possibly scrotal imaging. Second, this arm of the WHI involved the use of conjugated equine estrogens in combination with medroxyprogesterone in a sample of menopausal women, some of whom were as long as 10 years post-menopausal at the time of hormone initiation. It is aimed at a more general readership of physicians occasionally seeing adult transgender people. Overview of feminizing hormone therapy Primary author: Since these medications block neither the production nor action of testosterone, their antiandrogen effect is less than that encountered with full blockade.
An evaluation for testicular neoplasms should be performed with a scrotal exam as well as testing for elevated serum human chorianogonadotropin hCG , lactate dehydrogenase LDH , alpha-fetoprotein AFP levels, and possibly scrotal imaging. We assessed additional aspects of memory, including visual, spatial, object and location memory, other cognitive abilities that show reliable sex differences, including verbal and visual-spatial abilities, and mood variables that could mediate associations between estrogen and cognition. Antiandrogens - other approaches Antiandrogens can also be used alone to bring reduced masculinization and minimal breast development, or in those patients who wish to first explore reduced testosterone levels alone, or in those with contraindications to estrogen therapy. Blood samples were taken at intervals for testosterone and sex-hormone-binding globulin measurements and free testosterone levels were calculated. First, the transgender women may be at lower risk of breast cancer than non-transgender women. Sexual and gonadal effects include reduction in erectile function, changes in libido, reduced or absent sperm count and ejaculatory fluid, and reduced testicular size. The lack of significant effects did not relate to mood changes or to the sexual orientation of participants. Martin den Heijer, professor of endocrinology1 2, Alex Bakker, transgender man with 20 years of experience taking hormonal treatment, Louis Gooren, emeritus professor in transgender medicine2 1Department of internal medicine, VU Medical Center, Amsterdam, Netherlands 2Center of expertise on gender dysphoria, VU Medical Center, Amsterdam, Netherlands Correspondence to M den Heijer m. Hormone treatment for transgender people is usually initiated by specialist gender clinics, but some people start hormone treatment of their own accord without a prescription. Considering these differences in demographics and goals of therapy, extremely modest increase in overall risk, and lack of difference in mortality, as well as more recent reassuring data with other forms of estrogen, the risks of using progestagens in transgender women are likely minimal or even absent Grading: No outcome studies have been conducted on injectable estradiol valerate or cypionate, presumably due to their uncommon modern use outside of transgender care settings; due to this limited use manufacturers have little incentive to produce this medicine, and shortages have been reported. Side effects of estrogens may include migraines, mood swings, hot flashes, and weight gain. Several guidelines are available on the start of hormonal treatment; the focus of this article is the long term hormonal care for transgender people who might no longer attend a specialist clinic. Second, this arm of the WHI involved the use of conjugated equine estrogens in combination with medroxyprogesterone in a sample of menopausal women, some of whom were as long as 10 years post-menopausal at the time of hormone initiation. Androgen blockers allow the use of lower estradiol dosing, in contrast to the supraphysiologic estrogen levels and associated risks previously used to affect pituitary gonadotropin suppression. While concerns exist from the Women's Health Initiative WHI regarding risks of cardiovascular disease and breast cancer in the setting of medroxyprogesterone use, these concerns likely do not apply in the context of transgender care for several reasons. The most commonly used synthetic progestin in the context of transgender care is the oral medroxyprogesterone acetate Provera. Feminizing hormone therapy also brings about changes in emotional and social functioning. The general approach is similar to estrogen replacement in agonadal i. The actual findings in the conjugated equine estrogen plus medroxyprogesterone group were an excess absolute risk per 10 person-years of 7 more cardiac events events, 8 more strokes, 8 more pulmonary emboli, and 8 more invasive breast cancers, with no change in overall mortality. Erectile response to sexually arousing stimuli erotic films and self-generated fantasy was also assessed in the laboratory. The most common though rare side effects are venous thrombosis in trans women due to oestrogens and polycythaemia caused by androgens in trans men. In addition to comparing groups of individuals on and off estrogen, we used two repeated measures designs AB and BA. Compounded topical creams and gels also exist from specialty pharmacies; if these are to be used it is recommended that the prescriber consult with the compounding pharmacist to understand the specific details and dosing of the individual preparation. Unfortunately many of these characteristics are permanent upon completion of natal puberty and are irreversible. The present study used a more robust design to examine further associations between estrogen and cognition.
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