Metabolic Effects of Hormone Therapy in Transgender Patients

John David Fernandez, BA; Lisa R. Tannock, MD


Endocr Pract. 2016;22(4):383-388. 

In This Article

Abstract and Introduction


Objective: Transgender patients may seek hormone therapy to induce physical changes to simulate their expressed or experienced gender. However, many providers are uncomfortable prescribing transgender hormones due to fears over safety. The goal of this study was to determine if transgender hormone therapy with estrogen and spironolactone for male-to-female (MtF) patients or with testosterone for female-to-male (FtM) patients had adverse anthropomorphic or metabolic effects.

Methods: This retrospective chart review study analyzed changes over time for 33 MtF and 19 FtM endocrine clinic patients at an academic endocrine practice with follow-up for up to 18 months after hormone initiation.

Results: Compared to baseline labs obtained prior to the initiation of hormone therapy, significant changes for the MtF cohort included an increase in high-density lipoprotein (HDL) and decrease in creatinine; however, triglycerides did not show a statistically significant change. In the FtM cohort, there were significant increases in body mass index, creatinine, hemoglobin, and hematocrit. Although statistically significant, these changes were minimal for both cohorts.

Conclusion: In our practice, hormone therapy was found to be safe in this retrospective study.


Transgender is an umbrella term for people whose gender identity and/or gender expression differs from their natal sex. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, transgender individuals can be diagnosed with gender dysphoria, a term that describes the distress accompanying a marked difference in the expressed or experienced gender from their natal sex.[1] Recently, there has been a dramatic increase in public awareness of transgender individuals due to mainstream media exposure of celebrities such as the athlete Caitlyn Jenner and Orange is the New Black actress Laverne Cox. The increased visibility may also increase the patient population size through educating people about the existence of gender dysphoria and treatment options. According to one estimate, transgender people comprise approximately 0.3% of the U.S. population.[2] Therefore, it is vital to continue educating providers about the care and treatment of transgender individuals.

Individuals identifying as transgender often seek hormonal therapy. Estrogen, with or without the antiandrogenic effects of spironolactone, is prescribed for male-to-female (MtF) patients, and testosterone is prescribed for female-to-male (FtM) patients. The Endocrine Society published guidelines for the initiation and monitoring of transgender hormone therapy.[3] This therapy is meant to induce physical changes to simulate the patient's desired gender. However, the use of estrogen and testosterone has metabolic side effects, and many providers are uncomfortable with the use of hormone therapy regardless of whether it is used in same gender (cisgender) or transgender populations, especially due to the lack of knowledgeable providers on appropriate treatment options for transgender patients.[4] Risks associated with estrogen use include cancer risks, cardiovascular risks including thrombosis and hypertension, and weight changes, among others. The major risks associated with spironolactone include hyperkalemia and blood pressure effects, particularly if subjects have underlying renal or liver disease. Testosterone can increase the risk of cardiovascular disease, hypertension, and polycythemia; liver toxicity is more associated with oral than parenteral administration but remains a potential concern. Although transgender individuals are increasingly accessing the health care system to seek hormonal therapy, little is known regarding outcomes and prevalence of metabolic perturbations in the transcommunity. The primary goal of this study was to determine if transgender hormone therapy had any adverse anthropomorphic or metabolic effects in a "real-world" cohort.