Hormone replacement therapy (HRT)

Hormone Therapy for Transgender Individuals

            Hormone therapy is an important treatment for transgender and gender non-conforming individuals who feel uncomfortable with their gender. Before starting, talk to our specialists to understand and agree to the treatment. You'll typically need a referral letter. Here are the main criteria:

- Diagnosis of gender discomfort.

- Understanding the benefits and risks of hormone therapy.

- Starting at age 18, with parental permission if under 18.

- Maintaining good physical and mental health.

Feminizing Hormone Therapy (MtF)

1. Estrogen is used for hormone replacement, but avoid oral estrogen (Ethinyl estradiol) due to increased risk of blood clots. There are different estrogen preparations; discuss with your doctor for the best option.

2. Anti-androgen medication helps suppress testosterone:

   - Spironolactone inhibits testosterone but monitor blood pressure and electrolytes.

   - Cyproterone acetate is effective but watch for liver issues.

   - GnRH agonists block testosterone release but are costly and typically given as injections.

   - 5-alpha-reductase inhibitors have various benefits for hair growth and skin.

Masculinizing Hormone Therapy (FtM)

Testosterone can be taken orally, through the skin, or by injection. Aim for the lowest effective dose over time to achieve desired results while preserving bone density.

Physical Effects of Hormone Therapy

- For FtM patients: deeper voice, possible clitoral enlargement, more body hair, menstruation stops, less breast tissue, and increased muscle mass.

- For MtF patients: breast growth, reduced erectile function, smaller testicles, more body fat, and less muscle mass.

Changes occur gradually over about two years, but they vary for each person.

Administration:

          Hormones are typically administered through various routes, including oral pills, transdermal patches, injections, or topical creams/gels. The choice of administration method depends on factors such as individual preference, effectiveness, and potential side effects.

Hormone therapy is usually initiated at a low dose, with gradual dose increases over time to achieve desired effects while minimizing risks.

It's important for individuals undergoing hormone therapy to follow their healthcare provider's instructions regarding dosage, administration, and monitoring.

Health Monitoring:

Regular monitoring of hormone levels and overall health is essential to ensure the safety and effectiveness of hormone therapy. This may include blood tests to assess hormone levels, liver function, lipid profiles, and other relevant parameters.

Healthcare providers may also monitor for potential side effects or complications associated with hormone therapy, such as changes in blood pressure, cholesterol levels, or risk of blood clots.

Risk Assessment and Modification for Transgender Hormone.

When initiating hormone therapy for transgender individuals (male-to-female and female-to-male), it's essential to conduct a thorough risk assessment and consider potential modifications to minimize risks and optimize benefits. Here's an overview of the risk assessment process and potential modifications for hormone therapy:

• Comprehensive Medical History: Obtain a comprehensive medical history, including any pre-existing medical conditions, family history of medical conditions, current medications, and previous surgeries. Assessing baseline health status is crucial for identifying potential risks associated with hormone therapy.
• Physical Examination: Perform a physical examination to assess overall health, including vital signs, body mass index (BMI), and any physical findings that may impact hormone therapy decisions.
• Laboratory Testing: Conduct baseline laboratory testing to evaluate hormone levels, liver function, lipid profile, complete blood count (CBC), and other relevant parameters. This helps identify any underlying health concerns and establish baseline values for comparison during treatment.
• Cardiovascular Risk Assessment: Assess cardiovascular risk factors, including smoking status, hypertension, dyslipidemia, diabetes, and personal or family history of cardiovascular disease. Evaluate the individual's cardiovascular risk profile to determine potential risks associated with hormone therapy, such as increased risk of venous thromboembolism (VTE).
• Thromboembolic Risk Assessment: Evaluate thromboembolic risk factors, including personal or family history of VTE, obesity, immobility, and other risk factors. Transgender women (male-to-female) receiving estrogen therapy have an increased risk of VTE, so it's essential to assess individual risk factors and consider modifications to minimize this risk.
• Bone Health Assessment: Assess bone health status, including bone mineral density (BMD) measurement, to evaluate baseline bone density and fracture risk. Hormone therapy, particularly testosterone therapy in transgender men (female-to-male), may impact bone health over time, so monitoring bone density and providing appropriate interventions are important.
• Mental Health Evaluation: Evaluate mental health status, including assessing for depression, anxiety, and other mental health concerns. Addressing mental health issues and providing support are crucial components of transgender healthcare, especially during hormone therapy initiation.
• Discussion of Risks and Benefits: Engage in thorough discussions with the individual about the potential risks and benefits of hormone therapy, including potential side effects, long-term health implications, and expected outcomes. Informed consent is essential before initiating hormone therapy.

Getting to Khow: Homone Replacement Therapy

Why are mental health challenges in transgender people?

Transgender individuals may experience mental health challenges for various reasons, including Gender Dysphoria, Stigma, and Discrimination, Social Isolation, Access Barriers to Healthcare

FtM replacement Hormone Effective and Risk

 Masculinizing hormone therapy will induce physical changes that are more congruent with a patient’s gender identity In FtM patients, the following physical changes ..

MtF Replacement Hormone Effective and Risk

 Feminizing hormone therapy will induce physical changes that are more congruent with a patient’s gender identity. In MtF patients, the following physical changes are expected to occur:

Potential modifications to hormone therapy based on risk assessment may include:

1. Dose Adjustment: Individualize hormone therapy dosing based on risk factors, response to treatment, and desired outcomes. Adjust hormone dosages as needed to achieve therapeutic goals while minimizing adverse effects.
2. Monitoring and Surveillance: Implement regular monitoring and surveillance protocols to assess treatment response, monitor for adverse effects, and detect any potential complications early. This may include periodic laboratory testing, imaging studies, and clinical evaluations.
3. Lifestyle Modifications: Encourage lifestyle modifications to mitigate cardiovascular risk factors, such as smoking cessation, weight management, regular exercise, and healthy dietary habits. Addressing modifiable risk factors can help reduce the overall risk associated with hormone therapy.
4. Medical Interventions: Consider adjunctive medical interventions, such as antiplatelet therapy or prophylactic anticoagulation, in individuals at increased risk of thromboembolic events. Work closely with healthcare providers specializing in transgender healthcare to develop individualized treatment plans that address specific risk factors and optimize overall health outcome.

   It’s important to recognize that hormone therapy for transgender individuals is a complex and individualized process. Risk assessment and modification strategies should be tailored to each individual’s unique medical history, risk factors, preferences, and treatment goals. Collaboration between transgender individuals and healthcare providers is essential to ensure safe and effective hormone therapy initiation and management. At Kamol Hospital, we prioritize the well-being of our patients who choose to undergo hormone therapy. We take pride in providing comprehensive and multidisciplinary care.