Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline...F1000 Ranking: "Changes Clinical Practice"

María Ángeles Bazarra-Castro; Ulrich Renner; Gunter Stalla


Faculty of 1000 

Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ, Spack NP, Tangpricha V, Montori VM, Endocrine Society
J Clin Endocrinol Metab 2009 Sep 94(9):3132-54

Commentary from Faculty Members María Ángeles Bazarra-Castro, Ulrich Renner and Gunter Stalla

Changes Clinical Practice: The diagnosis and treatment of transsexuals should follow the recommendations proposed by Hembree and colleagues. Prepubertal children should not receive endocrine treatment, whilst transsexual adolescents (Tanner stage 2) should be treated with gonadotropin-releasing hormone (GnRH) analogues to suppress puberty until age 16, after which cross-sex hormones may be given. Endocrine treatment should be recommended and monitored by a mental health professional and confirmed by an endocrinologist. In adult patients, sex hormone levels should be maintained within the gender choice's appropriate limits.

Here, recommendations for the diagnosis and treatment of transsexuals are presented. The importance of this publication is owing to the proposed procedures, which are based on long-term and international experience. The treatment of transsexuals at our endocrine outpatient clinic is in agreement to these guidelines.

The lack of consensus on procedures in the treatment of transsexuals requires the attention of the accumulated experience localized in the few existing specialized centers. Hembree and colleagues propose a practice guideline based upon a consensus process with the committees of different endocrine societies. Their recommendation against the hormonal treatment of prepubertal children is based upon the uncertainty of the diagnosis in these cases. Although the diagnosis of transsexualism has to be made by a mental health professional, it is recommended that it is also confirmed by a treating endocrinologist who will then suggest the maintenance of cross-sex hormone levels in the normal range for the desired gender. Evaluation of cardiovascular risk factors and bone mineral density and screening for breast and prostate cancer are required during the follow up. Amongst the strengths of this publication is its well-referred mention of the previous research done in this area. However, the medical experience on this subject remains limited due to the restricted number of expert treating centers, the low prevalence of the diseases and the still-existing social stigma. At the endocrine outpatient clinic of the Max Planck Institute for Psychiatry in Munich, we have middle-term experience in the endocrine treatment of this type of patient. Recent work from our group showed no increase in prevalence of lifetime comorbidities in transsexual patients under hormonal treatment compared to control groups. Nevertheless, we have frequently encountered the appearance of side effects.[1] Further studies from our research have tried to clarify the etiology of this disease[2] and have given an overview about interesting social facets in this minority.



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