Endocrinological Care

I - Initial Evaluation

Clinical examination, medical history, and discussion about expected effects
Hormonal assays, biological assessment (initial assessment and risk factor screening)
Pelvic and testicular ultrasound if necessary

II – Hormone Therapy

The prescription of hormones must be validated during a multidisciplinary meeting. It will be adapted considering cardiovascular risk (smoking, diabetes, hypertension, obesity, etc.) and age.

This treatment will be prescribed during a consultation where all information regarding expected effects, potential side effects, and consequences on fertility will be explained to the person suffering from gender dysphoria.

It is strongly advised to stop smoking, maintain a healthy diet, and engage in regular physical activity.

It consists of two phases:

Blocking the hormones of the assigned sex

This blocking greatly facilitates the real-life experience
It will be stopped after surgical gonadectomy
For FtM: suppression of menstruation through the administration of progestins
For MtF: reduction of testosterone action and production through the administration of anti-androgens such as oral cyproterone acetate or, more rarely, GnRH agonists via subcutaneous or intramuscular injection

Administration of the hormones of the experienced sex

It allows the progressive development (first two years) of secondary sexual characteristics of the desired sex
This treatment will be continued long-term, notably to prevent osteoporosis
For FtM, androgen therapy is almost never stopped. Virilization will be achieved through intramuscular injection of Testosterone Enanthate.
Doses are gradually increased for better tolerance
For MtF, estrogen therapy will be discussed considering therapeutic imperatives related to menopause. Feminization is achieved through the administration of estrogens, 17 Beta Estradiol, orally for individuals without cardiovascular risk and young, transdermally (patch or gel) for older individuals or those with cardiovascular or thromboembolic risks.

Clinical Effects

For FtM: the voice becomes deeper, abdominal fat redistribution, increased muscle mass, hair growth, and libido
For MtF: moderate breast volume development, decreased libido, spontaneous erections, hair growth, and muscle mass, redistribution of fat to the buttocks and hips. The skin becomes softer and less oily

Side Effects

For FtM: weight gain, acne, hair loss, polycythemia, increased cardiovascular risk
For MtF: hyperprolactinemia, hypertension, pulmonary embolism, and deep vein thrombosis

Follow-up

Physical and biological examination every three to six months during the first two years. Then annual follow-up.
Biological tests: blood ionogram, Complete Blood Count, lipid profile, liver function tests, phosphocalcic assessment, fasting glucose, hormonal assays
Bone densitometry, echo Doppler
Mammography every two years for MtF
Follow-up will be long-term