Endocrine Care of Transpeople Part II

A Review of Cross-sex Hormonal Treatments, Outcomes and Adverse Effects in Transwomen

Maria Cristina Meriggiola; Giulia Gava


Clin Endocrinol. 2015;83(5):607-615. 

In This Article

Hormonal Treatment


The aim of treatment for transwomen adolescents is the same as for transmen which is to gain time to confirm the diagnosis by blocking the development of male secondary sexual characteristics such as pattern of body and facial hair, body fat distribution or low-pitched voice.[8] Once diagnosis is confirmed, cross-sex hormonal therapy (CHT) to induce the development of female sexual characteristics can be started. In transwomen, the suppression of puberty can be best achieved through GnRH analogue administration.[9,10] GnRH analogues are administered via monthly or three monthly injections and must be continued alongside oestrogens until gonadectomy is performed.[9] Induction of puberty is similar to hypogonadal females and in many countries is started at the age of 16 which is considered to be the legal age for taking decisions regarding medical treatment.[9] Puberty induction is started through gradual increments of oestradiol which can be adjusted according to clinical response and the patient's BMI.[9] The initial doses of oestrogens are not high enough to suppress endogenous sex steroids so GnRH should be continued. If GnRH analogues are discontinued, the dose of oestrogens needs to be almost doubled to ensure development of female secondary sexual characteristics and suppression of endogenous testosterone production.[9]


In adult transwomen where full development of male secondary sexual characteristics has already developed, the goal of CHT is the suppression of male characteristics and the development of feminine secondary sexual characteristics. To obtain these results, an almost complete suppression of endogenous testosterone production with combined administration of anti-androgens or GnRH analogues and oestrogens is required. Oestrogen administration should be continued also in the long term after gonadectomy to prevent hypogonadism.