Recommendations for Endocrine Treatment of Patients with Gender Dysphoria

The 2009 document reviews clinical guidelines for the endocrine treatment of gender dysphoria, covering hormone therapy for both trans women and trans men. It includes a literature search from 1998 to 2008 with 20 papers and emphasizes the importance of physical monitoring. For trans women, hormone treatments involve estrogens combined with GnRH agonists or anti-androgens, with specific monitoring protocols pre- and post-operatively, and a variety of hormone regimens are suggested. For trans men, testosterone therapy is the main treatment, with starting doses ranging from 50 to 80 mg every two weeks, and the potential use of progestins if menstruation persists. Side effects such as polycythemia and liver dysfunction are noted, and the importance of informed consent and realistic expectations is highlighted. The document also cites studies with 60 and 39 participants, as well as clinical experiences, and recommends the use of a GnRH agent to minimize the need for higher doses of sex steroids and reduce side effects, with regular monitoring advised.