With increasing numbers of transgender and gender non-binary individuals presenting for care, knowing how to elucidate the mental health and cognitive outcomes of gender-affirming hormone therapy GAHT is necessary. This article reviews the present literature covering GAHT effects on mood, behavioral health, and cognition in these individuals and offers research priorities to address knowledge gaps. Although there are some conflicting data, GAHToverwhelmingly seems to have positive psychological effects in both adolescents and adults. Research tends to support that GAHT reduces symptoms of anxiety and depression, lowers perceived and social distress, and improves quality of life and self-esteem in both male-to-female and female-to-male transgender individuals. Clinically, prescribing GAHT can help with gender dysphoria-related mental distress.
Sex beyond the genitalia: the human brain mosaic. Studies looking at the effects of estrogen on cardiovascular disease in transgender women are not very conclusive, but do show that there may therayp a trend toward an increased risk of heart disease, which should be further studied. A renaissance for parenteral estrogen]. Prostate cancer is extremely rare in gonadectomized transgender women Transexual hormone therapy have been treated with estrogens for a prolonged period of time. Transexual hormone therapy this reason, many seek breast augmentation. Psychopathological parameters Symptom Checklistpsychosocial variables psychosocial questionnaires. JAMA Dermatol. Prostate Suppl. Monitor for feminizing and Bleeding hormones pregnancy effects every 3 months for the first year, then every 6—12 months.
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Meyer; Mary E. Typically, people who seek hormond hormone therapy experience distress due to a difference between experienced or expressed gender and sex assigned at birth gender dysphoria. Non-binary or Transexual hormone therapy people may also undergo hormone therapy in order to achieve a desired balance of sex hormones. These release hormones directly into the bloodstream so that they are carried all round the body. Progestogens and antiprogestogens. Use of gonadotropin-releasing hormone Gn-RH analogs to suppress testosterone production might allow you to take lower estrogen doses and wouldn't require the use of spironolactone. The tests to diagnose liver metastases are the following: CT or MR Magnetic Resonanceliver function Transexual hormone therapy, liver ultrasound and liver biopsy. HRT is safe when done under proper medical supervision with regular blood tests to ensure that everything is fine. This article does not hkrmone the information I am looking for. This Transexual hormone therapy can be weekly or biweekly depending on the individual patient. This can cause a reduction in total body height. The Transgender Pictures of tattoos on a vagina Reader.
Many transgender men and women seek hormone therapy as part of the transition process.
- Editor's Note: While discussion of hormone replacement therapy HRT and its medications is permitted, discussing the means to acquire them without a prescription, and self medication without a doctors care is prohibited.
- Some transgender people choose to undergo hormone therapy HRT to masculinise or feminise their bodies.
- There are many different hormones produced in the body by a system of glands.
- Current Opinion in Endocrinology, Diabetes and Obesity 20 6 :
With increasing numbers of transgender and gender non-binary individuals presenting for care, knowing how to elucidate the mental health and cognitive outcomes of gender-affirming hormone therapy GAHT is necessary. This article reviews the present literature covering GAHT effects on mood, behavioral health, and cognition in these individuals and offers research priorities to address knowledge gaps.
Although there are some conflicting data, GAHToverwhelmingly seems to have positive psychological effects in both adolescents and adults. Research tends to support that GAHT reduces symptoms of anxiety and depression, lowers perceived and social distress, and improves quality of life and self-esteem in both male-to-female and female-to-male transgender individuals.
Clinically, prescribing GAHT can help with gender dysphoria-related mental distress. Thus, timely hormonal intervention represents a crucial tool for improving behavioral wellness in transgender individuals, though effects on cognitive processes fundamental for daily living are unknown.
Future research should prioritize better understanding of how GAHT may affect executive functioning. Although people tend to use the terms sex and gender interchangeably, each has a distinct meaning.
A newborn is typically designated a sex —either male or female—based on the appearance of their genitalia. Natal sex and sex assigned at birth are used interchangeably in this article to refer to this same concept. On the other hand, the term gender identity refers to an internal sense of self, which can be man, woman, a mix of both, or neither.
For many, their sex assigned at birth is in accordance with their gender identity. These people are cisgender abbreviated cis. Transgender abbreviated trans is an umbrella term that describes those who do not have a gender identity, gender expression i. Trans women often labeled by the medical community as male-to-female or MTF were assigned male at birth but identify as women. On the other hand, trans men often labeled by the medical community as female-to-male or FTM were assigned female at birth but identify as men.
However, gender and sex are on a spectrum with many possibilities. Focusing on the two ends of the gender spectrum leaves out identities which lie outside of the male-female binary. The transgender experience has previously been coded by the American Psychiatric Association as a pathological condition called gender identity disorder GID in the Diagnostic and Statistical Manual of Mental Disorders DSM third and fourth editions [ 3 , 4 ].
However, due to variation in diagnosis, presentation, and cultural acceptability across different nations and societies and associated stigma with trans identification, these numbers likely underestimate the true prevalence. Today, not all transgender individuals experience sufficient symptoms of gender dysphoria to meet criteria for the diagnosis. However, the dichotomy between the female and male brain is not always clear-cut. Brain regions are programmed by androgens and estrogens to various degrees leading to a gradient of masculinization and feminization across the brain during prenatal development.
A legal transition includes a change in name and new legal documents to reflect this. Medical transition if desired may include procedures such as gender-affirming hormone therapy GAHT and gender-affirming surgery e.
MTFs typically take estradiol and androgen blockers to feminize their bodies, while FTMs typically take testosterone to masculinize their bodies. Empirical evidence in cisgender participants suggests differences between the sexes with respect to cognition. Specifically, there is a sex distinction between spatial intelligence and verbal intelligence, although both cisgender males and females have similar overall IQ.
Males tend to outperform females in spatial rotation tasks, and females outperform males in tasks requiring verbal fluency [ 16 , 17 ]. Based on the literature in cisgender populations, it is known that estradiol, testosterone, and progesterone—as well as its neurosteroid metabolite allopregnanolone Allo —have strong influence on neurotransmitter levels and receptors, as well as neuronal and glial architecture and function in presumably cisgender individuals [ 14 , 30 , 31 ].
Since changes in these gonadal and adrenal steroid levels can profoundly affect cognition and mood [ 14 , 32 ], exogenous hormone administration by GAHT must further be studied to better inform patients about potential changes in executive functioning and behavioral health. Only a few studies have prioritized brain health as a function of exogenous hormone administration, which is the focus of this review. Our purpose is to provide the clinician with a comprehensive review of these recent studies so that they can approach their transgender patients with greater understanding of the potential behavioral health impact of GAHT.
Single case reports, review articles, commentaries, and studies that did not contain original data were excluded. Adolescents and children taking only puberty blockers were not considered in this review; interventions were restricted to either feminizing or masculinizing hormone therapy.
Due to the large range of doses and types of GAHT, all styles of hormone administration, dosing levels, dose frequency, and types were included. Overall, GAHT has been found to influence both mood and cognition in transgender adults. Longitudinal studies assessing GAHT effects on behavioral health in transgender individuals. Depression and related mood states are extensively studied behavioral health-related parameters in transgender and gender dysphoric individuals undergoing GAHT.
A limitation of these investigations is that none of the three documented hormone blood levels before or after GAHT. Additionally, subjects received varying levels of hormones. Future research questions lie in considering the significance of doses, route of administration, and dosing schedules in GAHT.
As opposed to depression, anxiety has been investigated only recently. Comparison across studies may have limited utility due to different scales used to measure anxiety symptoms. Bouman et al. Using the Minnesota Multiphasic Personality Inventory MMPI , three studies suggest a positive effect of GAHT on personality-related psychopathology as well, including significant reductions in psychasthenia, depression, hysteria, and paranoia [ 37 , 38 , 51 ].
Longitudinal studies completed in Turkey [ 39 ] and the Netherlands [ 52 ] find that GAHT generally has a positive impact on general psychopathological symptoms and functioning and general well-being Table 1. However, the de Vries et al. Based on the limited literature, GAHTseems to have a mixed effect on emotional functioning. While some indicate that testosterone treatment in FTMs is associated with improved mental health on measures of anger [ 45 ], there is a report of increased anger expression after 7 months of continuous testosterone [ 40 ].
Interestingly, despite the increase in anger expression scores, this same study noted an improvement in inner ability to control angry feelings, possibly due to greater self-confidence and social functioning from affirmation in the male gender role. Rather, Defreyne et al. This potential contribution raises the probability of extra variables besides GAHT that may be affecting anger and aggression. Nonetheless, the existence of very few studies on this subject warrants further investigation.
One study showed that following GAHT, MTFs experienced less body uneasiness, but FTMs did not share the same benefit, possibly due to discomfort at a personal rather than social level [ 54 ]. Finally, noticeable decreases in eating disorder psychopathology and symptoms were documented by Testa et al. Since all three of these studies—only one [ 39 ] of which was longitudinal Table 1 —were conducted in different countries USA, Canada, UK, Turkey using different questionnaires, cross-cultural comparison among these data should be approached cautiously.
To the best of our knowledge, no studies thus far have looked at how GAHT influences executive function and cognitive domains used for daily living. Overall, this review demonstrates that GAHT generally has positive effects at multiple levels on mood and behavioral health of transgender and gender dysphoric individuals.
Whether the impact of GAHTon the limited cognitive domains assessed actually leads to improvements in cognitive domains which are critical to day-to-day function is not known.
It is critical that upcoming research interests consider the brain domains important for goal-directed behavior and pay less attention to sex-specific cognitive processes. Research over the past few decades has also established that, following GAHT, transgender individuals report decreased anxiety, perceived stress, and social distress and report better mental health-related quality of life, self-esteem, and mood.
However, some inconsistencies around GAHT effects on anger and aggression still need to be addressed. Although the existing body of research supports GAHT improving mental wellness, many studies used cross-sectional and uncontrolled observational methods relying on self-report. We argue that lines of research focusing on differences between trans populations and general population controls without a specific intervention do not answer critical questions about how to improve the unique health needs of transgender people and can further stigmatize this community by deeming them as abnormal.
Specifically, gonadal steroids can have great impact on brain structure, function, regional connectivity, and neurochemistry [ 14 ], which influences executive functions, affect, and reward processing. The prefrontal cortex—the site of estrogen modulation of executive function—is essential for cognitive processes such as sustained attention, working memory, organization, and planning [ 14 , 31 , 62 ]. FTM individuals taking high-dose testosterone and left in a hypoestrogenic and hypertestosteronic state could be at risk for executive dysfunction, as exhibited in cisgender females experiencing premature loss of estradiol or polycystic ovary syndrome, respectively [ 63 , 64 ].
The editors would like to thank Dr. Bradley Gaynes for taking the time to review this manuscript. Conflict of Interest Hillary B. Nguyen, Alexis M. Kornfield, Robert D. Davies, and C. Neill Epperson declare no conflict of interest. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors. National Center for Biotechnology Information , U.
Curr Psychiatry Rep. Author manuscript; available in PMC Jan Hillary B. Nguyen , 1, 2, 3, 4 Alexis M. Kornfield , 3 Robert D. Davies , 4 and C.
Neill Epperson 2, 3, 4. Alexis M. Sara L. Robert D. Neill Epperson. Author information Copyright and License information Disclaimer. Corresponding author. Copyright notice. The publisher's final edited version of this article is available at Curr Psychiatry Rep. See other articles in PMC that cite the published article.
Abstract Purpose of Review With increasing numbers of transgender and gender non-binary individuals presenting for care, knowing how to elucidate the mental health and cognitive outcomes of gender-affirming hormone therapy GAHT is necessary. Recent Findings Although there are some conflicting data, GAHToverwhelmingly seems to have positive psychological effects in both adolescents and adults.
Introduction Background Although people tend to use the terms sex and gender interchangeably, each has a distinct meaning. MTFs reported a statistically significant improvement in the quality of their sexual life and in the general quality of life 1 year after GAHT initiation. There were also significant increases in masculinity-femininity scores, which may indicate endorsing stereotypical masculine interests and discomfort with the female gender role. In summary, testosterone GAHT resulted in higher psychological functioning on multiple domains in transgender men relative to non-transgender male and female controls.
Drug Saf. The first description of this kind was made in by R. Your Email:. The femora also widen, because they are connected to the pelvis. Otherwise, screening can start at age 60 or earlier if sex hormone levels are consistently low. Craig Jordan; Barrington J.
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Transgender hormone therapy - Wikipedia
This form of hormone therapy is given as one of two types, based on whether the goal of treatment is feminization or masculinization :. Some intersex people may also undergo hormone therapy, either starting in childhood to confirm the sex they were assigned at birth , or later in order to align their sex with their gender identity.
Non-binary or genderqueer people may also undergo hormone therapy in order to achieve a desired balance of sex hormones. Many centers how use an informed consent model that does not require any routine formal psychiatric evaluation but instead focuses on reducing barriers to care by ensuring a person can understand the risks, benefits, alternatives, unknowns, limitations, and risks of no treatment.
The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People SOC require that the patient be referred by a mental health professional who has diagnosed the patient with persistent gender dysphoria.
The Standards also require that the patient give informed consent , in other words, that they consent to the treatment after being fully informed of the risks involved.
Feminizing hormone therapy usually includes medication to suppress testosterone production and induce feminization. Types of medication include testosterone blockers, estrogen, and progesterone. After six to eight weeks of spironolactone therapy, estrogen can be started to further suppress testosterone production and promote feminization. Masculinizing hormone therapy usually includes testosterone to suppress the production of estrogen.
Dosing is patient specific and is discussed with the physician. This dosing can be weekly or biweekly depending on the individual patient. Hormone therapy for transgender individuals has been shown in medical literature to be generally safe, when supervised by a qualified medical professional. Transgender hormone therapy replacement may limit fertility potential. Options include semen cryopreservation , oocyte cryopreservation , and ovarian tissue cryopreservation. A study due to be presented at ENDO the Endocrine Society 's conference reportedly shows that even after one year of treatment with the hormone testosterone , a transgender man can preserve his fertility potential.
Psychiatric conditions can commonly accompany or present similar to gender incongruence and gender dysphoria. For this reason, patients are assessed using DSM-5 criteria or ICD criteria in addition to screening for psychiatric disorders. The Endocrine Society requires physicians that diagnose gender dysphoria and gender incongruence to be trained in psychiatric disorders with competency in ICD and DSM The healthcare provider should also obtain a thorough assessment of the patient's mental health and identify potential psychosocial factors that can affect therapy.
The ICD system requires that patients have a diagnosis of either transsexualism or gender identity disorder of childhood. The criteria for transsexualism include: . Individuals cannot be diagnosed with transsexualism if their symptoms are believed to be a result of another mental disorder , or of a genetic or chromosomal abnormality. For a child to be diagnosed with gender identity disorder of childhood under ICD criteria, they must be pre-pubescent and have intense and persistent distress about being the opposite sex.
The distress must be present for at least six months. The child must either:. The DSM-5 states that at least two of the following criteria must be experienced for at least six months' duration for a diagnosis of gender dysphoria : . In addition, the condition must be associated with clinically significant distress or impairment.
Some organizations — but fewer than in the past — require that patients spend a certain period of time living in their desired gender role before starting hormone therapy. This period is sometimes called real-life experience RLE. The Endocrine Society stated in that individuals should either have a documented three months of RLE or undergo psychotherapy for a period of time specified by their mental health provider, usually a minimum of three months.
Transgender and gender non-conforming activists, such as Kate Bornstein , have asserted that RLE is psychologically harmful and is a form of "gatekeeping", effectively barring individuals from transitioning for as long as possible, if not permanently. Some transgender people choose to self-administer hormone replacement medications, often because doctors have too little experience in this area, or because no doctor is available.
Others self-administer because their doctor will not prescribe hormones without a letter from a psychotherapist stating that the patient meets the diagnostic criteria and is making an informed decision to transition. Because many individuals must pay for evaluation and care out-of-pocket , costs can be prohibitive. Access to medication can be poor even where health care is provided free.
The report concluded in part: "The NHS must provide a service that is easy to access so that vulnerable patients do not feel forced to turn to DIY remedies such as buying drugs online with all the risks that entails. Patients must be able to access professional help and advice so that they can make informed decisions about their care, whether they wish to take the NHS or private route without putting their health and indeed their lives in danger.
From Wikipedia, the free encyclopedia. Health care and medicine. Rights issues. Society and culture. Theory and concepts. By country. See also. See also: Transgender hormone therapy male-to-female. See also: Transgender hormone therapy female-to-male. See also: Real-life experience transgender. Transgender portal. November 30, Teen Vogue. Deutsch MB, ed. June Available at transcare. Howard Brown.
Archived from the original on Retrieved August International Journal of Transgenderism. Updated recommendations from the world professional association for transgender health standards of care. Am Fam Physician. December Translational Andrology and Urology. Feb May Current Opinion in Endocrinology, Diabetes and Obesity. Human Reproduction Oxford, England. ICDVersion Archived from the original PDF on New York: Routledge.
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