FRIDAY, Sept. 25 (HealthDay News) -- A new clinical practice guideline offers advice for the endocrine treatment of transsexuals, according to a special article published in the September Journal of Clinical Endocrinology & Metabolism.
Wylie C. Hembree, M.D., of Columbia University in New York City, and colleagues developed a practice guideline and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to assess the strength of recommendations and the quality of supporting evidence, which they describe as low or very low.
The researchers write that transsexual people seeking to develop physical characteristics of the desired gender need a safe, effective hormone regimen. They advise against endocrine treatments for pre-pubertal children, and say that endocrine treatments for adolescents and adults should be based on a recommendation from mental health professionals whose diagnostic criteria are confirmed by the endocrinologist. In transsexual adolescents, they recommend puberty-suppressing treatment with GnRH analogues until the age of 16 years, possibly followed by the use of cross-sex hormones. In adults, they recommend the suppression of endogenous sex hormones, maintenance of gender-appropriate sex-hormone levels, and monitoring for known risks.
"When a transsexual individual decides to have sex reassignment surgery, both the endocrinologist and the mental health professional must certify that he or she satisfies the eligibility and readiness criteria of the standards of care," the authors write. "There is some concern that estrogen therapy may cause an increased risk for venous thrombosis during or after surgery. For this reason, the surgeon and the endocrinologist should collaborate in making a decision about the use of hormones during the month before surgery."
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