Endocrine Abstracts

Gender identity disorder is not a rare condition occurring in 1:7440 born male and 1:31 153 born female individuals. Although gender transition is supervised in specialist clinics, post transition the patients are discharged back to primary or secondary care follow up. In my session I will discuss the process of gender transition, common hormonal regimens used and their monitoring. I will also discuss safety studies and the monitoring of long term follow up of individuals taking cross sex hormone therapy.

For transmen standard hormone replacement doses of androgen appear to be adequate for general long term health. Although cardiovascular risk in transmen is increased compared to the female population the myocardial infarction risk is still only one third the general male population.

In transwomen oestrogen doses of up to 5-times standard hormone replacing doses are used. In transwomen the risk of DVT is 20-fold the general population, however it appears that they oestrogen type used is important in this risk and modern regimens using oestradiol are much safer than older regimens using premarin. Similarly recent studies suggest that the use of ethinyl oestradiol is associated with and increased risk of cardiovascular events compared with other forms of oestrogen and has implications for the long term management of oestrogen replacement. The breast cancer risk of transwomen is however minimal. The studies support the use of oestradiol as the safest form of oestrogen in transwomen.

Overall the long term safety of hormone replacement in trans-patients is safe with a standard mortality ratio of 1 compared with the general population.

Declaration of interest

I fully declare a conflict of interest. I have performed paid lectures for Bayer and Pfiser.