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Endocrinology of transgender medicine



Jon Arcelus

Louis Gooren

Daniel T. Klink

Vin Tangpricha


Gender affirming treatment for transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen lowering medications. Feminizing treatment with estrogens and anti-androgens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk of venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses plus increase of muscle mass, facial and body hair. Due to the lack of evidence, treatment for gender non-binary people should be individualized. Young people may receive pubertal suspension, consisting of gonadotrophin-releasing hormone analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur, but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to effect of gender affirming treatment in the non-binary population.


T’Sjoen, G., Arcelus, J., Gooren, L., Klink, D. T., & Tangpricha, V. (2019). Endocrinology of transgender medicine. Endocrine Reviews, 40(1), 97–117.

Journal Article Type Article
Acceptance Date Jun 21, 2018
Online Publication Date Oct 10, 2018
Publication Date 2019-02
Deposit Date Jun 22, 2018
Publicly Available Date Oct 11, 2019
Journal Endocrine Reviews
Print ISSN 0163-769X
Electronic ISSN 0163-769X
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 40
Issue 1
Pages 97–117
Keywords transgender, gender identity, testosterone, estrogen, anti-androgen, puberty
Public URL
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