Transgender hormone therapy: understanding international variation in practice

Abstract

The management of gender dysphoria varies substantially around the world, with respect to models of service delivery, individual eligibility and funding for transition, access to relevant specialists, as well as cultural, religious, and legal factors, and to the cross-sex hormone treatment (CSHT) regimens used. Different countries and cultures also vary in their sociocultural tolerance of gender fluidity during the process of transition. In this Comment, we highlight contrasting practices in five countries where gender reassignment is well established, including both high-income and lower-income nations, and those in which state involvement in health care ranges from minimal to highly centralised. We focus on the UK, the USA, and Iran, but also refer to Thailand and the Netherlands; Iran and Thailand are have the highest numbers of gender reassignment surgical procedures worldwide. Oestrogen and anti-androgen therapy for transgender womenTransgender women experience lifelong gender dysphoria due to a gender assignment at birth that is incongruent with their gender identity. They often seek hormone therapy, with or without surgery, to improve their gender dysphoria and to better align their physical and psychological features with a more feminine gender role. Some of the desired physical changes from oestrogen and anti-androgen therapy include decreased body and facial hair, decreased muscle mass, breast growth, and redistribution of fat. Full-Text PDF Testosterone therapy for transgender menTestosterone therapy is a cornerstone of medical treatment for transgender men who choose to undergo it. The goal of testosterone therapy is usually to achieve serum testosterone concentrations in the male reference range. Testosterone has several desired effects as well as undesired and unknown effects. The desired effects include increased facial and body hair, increased lean mass and strength, decreased fat mass, deepening of the voice, increased sexual desire, cessation of menstruation, clitoral enlargement, and reductions in gender dysphoria, perceived stress, anxiety, and depression. Full-Text PDF