Physiologic Response to Gender-Affirming Hormones Among Transgender Youth



      The purpose of this study was to examine the physiologic impact of hormones on youth with gender dysphoria. These data represent follow-up data in youth ages 12–23 years over a two-year time period of hormone administration.


      This prospective, longitudinal study initially enrolled 101 youth with gender dysphoria at baseline from those presenting consecutively for care between February 2011 and June 2013. Physiologic data at baseline and follow-up were abstracted from medical charts. Data were analyzed by descriptive statistics.


      Of the initial 101 participants, 59 youth had follow-up physiologic data collected between 21 and 31 months after initiation of hormones available for analysis. Metabolic parameters changes were not clinically significant, with the exception of sex steroid levels, intended to be the target of intervention.


      Although the impact of hormones on some historically concerning physiologic parameters, including lipids, potassium, hemoglobin, and prolactin, were statistically significant, clinical significance was not observed. Hormone levels physiologically concordant with gender of identity were achieved with feminizing and masculinizing medication regimens. Extensive and frequent laboratory examination in transgender adolescents may be unnecessary. The use of hormones in transgender youth appears to be safe over a treatment course of approximately two years.


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        • Spack N.P.
        • Edwards-Leeper L.
        • Feldman H.A.
        • et al.
        Children and adolescents with gender identity disorder referred to a pediatric medical center.
        Pediatrics. 2012; 129
        • Khatchadourian K.
        • Amed S.
        • Metzger D.L.
        Clinical management of youth with gender dysphoria in Vancouver.
        J Pediatr. 2014; 164: 906-911
        • Olson J.
        • Schrager S.M.
        • Belzer M.
        • et al.
        Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria.
        J Adolesc Health. 2015; 57: 374-380
        • Smith Y.L.
        • Van Goozen S.H.
        • Kuiper A.J.
        • Cohen-Kettenis P.T.
        Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals.
        Psychol Med. 2005; 35: 89-99
        • Delemarre-van de Waal H.A.
        • Cohen-Kettenis P.T.
        Clinical management of gender identity disorder in adolescents: A protocol on psychological and paediatric endocrinology aspects.
        Eur J Endocrinol. 2006; 155: S131-S137
        • Olson J.
        • Garofalo R.
        The peripubertal gender-dysphoric child: Puberty suppression and treatment paradigms.
        Pediatr Ann. 2014; 43: e132-e137
        • Weinand J.S.J.
        Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals.
        J Clin Transl Endocrinol. 2015; 2: 55-60
        • Asscheman H.
        • T'Sjoen G.
        • Lemaire A.
        • et al.
        Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: A review.
        Andrologia. 2014; 46: 791-795
        • Gooren L.J.
        • Giltay E.J.
        • Bunck M.C.
        Long-term treatment of transsexuals with cross-sex hormones: Extensive personal experience.
        J Clin Endocrinol Metab. 2008; 93: 19-25
        • Jacobeit J.W.
        • Gooren L.J.
        • Schulte H.M.
        Long-acting intramuscular testosterone undecanoate for treatment of female-to-male transgender individuals.
        J Sex Med. 2007; 4: 1479-1484
        • Roberts T.K.
        • Kraft C.S.
        • French D.
        • et al.
        Interpreting laboratory results in transgender patients on hormone therapy.
        Am J Med. 2014; 127: 159-162
        • Asscheman H.
        • Gooren L.J.
        • Assies J.
        • et al.
        Prolactin levels and pituitary enlargement in hormone-treated male-to-female transsexuals.
        Clin Endocrinol (Oxf). 1988; 28: 583-588
        • Asscheman H.
        • Giltay E.J.
        • Megens J.A.
        • et al.
        A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones.
        Eur J Endocrinol. 2011; 164: 635-642
        • Baba T.
        • Endo T.
        • Honnma H.
        • et al.
        Association between polycystic ovary syndrome and female-to-make transsexuality.
        Hum Reprod. 2007; 22: 1011-1016
        • Jarin J.
        • Pine-Twaddell E.
        • Trotman G.
        • et al.
        Cross-sex hormones and metabolic parameters in adolescents with gender dysphoria.
        Pediatrics. 2017; 139
        • Franks S.
        Regulation of prolactin secretion by oestrogens: Physiological and pathological significance.
        Clin Sci. 1983; 65: 457-462
        • Rosenthal S.M.
        Approach to the patient: Transgender youth: Endocrine considerations.
        J Clin Endocrinol Metab. 2014; 99: 4379-4389
        • Hembree W.C.
        • Cohen-Kettenis P.
        • Delemarre-van de Waal H.A.
        • et al.
        Endocrine treatment of transsexual persons: An Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2009; 94: 3132-3154

      Linked Article

      • Collaboration Is Key to Developing Effective Hormonal Treatment Paradigms for Transgender Youth
        Journal of Adolescent HealthVol. 62Issue 4
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          There is an increasing demand for safe and effective multidisciplinary care of transgender youth who experience gender dysphoria based on an incongruence between sex assigned at birth and gender identity. Based on best existing evidence at the time, prior guidelines acknowledged indication for treatment with gonadotropin-releasing hormone agonists to suppress progression of puberty at Tanner stage 2 and consideration for treatment with sex steroids from approximately age 16 years [1]. In recognition of emerging evidence and evolving trends in clinical practice of care of transgender youth and adults, the Endocrinology Society recently published the updated “Clinical Practice Guidelines, Endocrine Treatment of Gender Dysphoria/Gender-Incongruent Persons” [2].
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