Prescribing for transgender patients

Supporting gender-affirming treatment

With greater awareness and social acceptance, increasing numbers of transgender individuals are asking about gender-affirming hormone treatment. Although prescribing remains off label, as the hormones are not specifically approved for this use, treatments are relatively straightforward and safe.

An article in the latest edition of Australian Prescriber describes gender-affirming hormone therapy for transgender patients. This therapy follows similar principles to the treatment of postmenopausal women and men with low testosterone.

The author, Sydney sexual health physician Louise Tomlins, advises that medical treatment should only occur after a thorough psychosocial assessment has been undertaken by a clinician experienced in the field.

“Some transgender individuals feel that a change in gender role or expression is sufficient. Others may require masculinising or feminising hormones, and in some cases surgery to address the psychological distress of their gender dysphoria,” she says.

The standard choice of hormones for people assigned male at birth transitioning to female gender are estradiols, which most closely resemble the ovarian hormone, in combination with anti-androgens which reduce masculine characteristics. Those assigned female at birth transitioning to male gender are given testosterone. Hormone concentrations should be monitored at three-monthly intervals initially.

“The treatment of young people is best undertaken by a multidisciplinary team specialised in the area,” says Dr Tomlins.

“The treatment varies according to the child’s stage of puberty. The puberty-suppression phase is reversible using a hormone to pause the development of secondary sex characteristics. The gender-affirming phase entails the introduction of hormones to develop the secondary sex characteristics of the preferred gender and minimise those of the birth gender.

“The timing of the gender-affirming treatment depends on the cognitive maturity of the adolescent and their ability to consent to the potentially irreversible effects of treatment,” says Dr Tomlins.

Read the full article

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Matthew Harris
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Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals. It is published by NPS MedicineWise, an independent, not-for-profit organisation for quality use of medicines funded by the Australian Government Department of Health. Australian Prescriber is published every two months and is available online at nps.org.au/australianprescriber.