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Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects
  • Source : Document PDF (Anglais)
  • Auteur(s) : The Journal of Clinical Endocrinology & Metabolism 88(8):3467–3473
    Eva Moore, Amy Wisniewski, and Adrian Dobs
    Departments of Medicine and Pediatrics, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287

  • Année : 2003
  • Commentaires sur ce document : Aucun commentaire référencé. Vérifiez qu'il n'existe pas déjà un sujet ouvert.
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Note d'Abigael :
Ce document étant en langue Anglaise je ne poste ici que la conclusion. Vous trouverez l'intégralité du texte dans le document PDF téléchargeable.
Copie partielle du document (la conclusion) :

Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects

(...)

Important comment
Our results show variation among treatment centers with published endocrinological guidelines for the treatment of transsexual people. This is particularly apparent in regard to estrogen dose in people of older ages and the addition of a progestin and/or antiandrogen to the treatment regimen. Results from our survey of MtF transsexual people demonstrated markedly elevated hormone doses and even greater complexity in their treatment regimens. Estrogen doses were often at alarming levels, and multiple formulations were used. This phenomenon has also been observed by other experienced physicians (6, 21, 26, 28, 60, 61). Doses reported by transsexual people were presumed to reflect their personal understanding or experience of what is necessary for their desired physical change. However, to our knowledge no study has evaluated the degree of desired effects seen with these extreme hormonal levels. Modest increases in cross-sex hormones did not show greater efficacy in the few studies available. Instead, other means for more desirable feminine characteristics were advocated by experienced clinicians such as surgery, electrolysis, and/or speech therapy.

Masculinizing therapy for FtM transsexual people was simpler in comparison, with fewer variations between patients and providers. Nevertheless, appropriate dosing was more subjective because clinical markers were better indications of adequate therapy than hormonal levels. Experience has been limited by the small amount of patients that present to treatment centers.

Congruent expectations of transsexual people and providers are crucial to minimize adverse effects. Health risks associated with low-dose sex steroid administration have been reported by the Woman’s Health Initiative (24). Our review suggested that morbidity and mortality associated with cross-sex hormone administration in transsexual people may be associated with much higher risks. Further studies of the long-term implications of cross-sex hormonal administration in transsexual people are needed. Education and close medical monitoring of patients are important aspects of treating transsexual people. After thorough review of the literature, our recommendations for endocrine treatment and monitoring are reported (Table 3).

Feminizing regimens include estrogens used in doses double to those used in hypogonadal women with the goal to suppress testosterone and maintain estrogen at feminine levels. Antiandrogens can be added if testosterone is difficult to suppress with this estrogen dose alone. Some have benefit with the addition of a progestin. Likewise, masculinizing regimens should be similar to that used in hypogonadal men with the goal to keep testosterone in the mid-male range. After gonadectomy, these doses can be substantially decreased while maintaining the above serum levels.

erious adverse effects are apparent in MtF transsexual people. FtM may also experience serious adverse effects, including cardiovascular and gynecological risks. Monitoring of the endometrium by yearly ultrasound is indicated. Any vaginal bleeding after prolonged therapy warrants an endometrial biopsy. Newer, transdermal applications should be considered because they may provide a more consistent hormone level and may decrease severe adverse effects. Close monitoring and yearly reevaluation of treatment are also important to minimize the adverse effects while maximizing the benefits. Age appropriate screening and preventive care for the biological sex of patients is also essential. Randomized clinical trials are needed to build on the years of clinical contributions to this field.

(...)
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Poster un nouveau sujet Cacaboudin, ce sujet est verrouillé, vous ne pouvez pas éditer de messages ou poster d’autres réponses.  [ 1 message ] 

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