Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence.
BACKGROUND
Data on the effects of cross-sex hormone therapy (CHT) are limited due to the low prevalence of gender dysphoria, small number of subjects treated at each center, lack of prospective studies, and wide variations in treatment modalities.


OBJECTIVE
The aim of this study is to report the short-term effects of CHT on hormonal and clinical changes, side effects, and adverse events in trans men (female-to-male gender dysphoric persons) and trans women (male-to-female gender dysphoric persons).


METHODS
This was a multicenter 1-year prospective study in 53 trans men and 53 trans women. Trans men received injections of testosterone undecanoate every 3 months. Trans women younger than 45 years received 50 mg cyproterone acetate (CA) and 4 mg estradiol valerate daily, whereas those older than 45 years received 50 mg CA daily together with 100 μg/24 hours transdermal 17-β estradiol.


METHODS
Sex steroids, prolactin, liver enzymes, lipids, hematocrit, blood pressure, anthropometrics, Ferriman and Gallwey score, and global acne grading scale were measured. Side effects, adverse events, and desired clinical changes were examined.


RESULTS
No deaths or severe adverse events were observed. Two trans men developed erythrocytosis, and two had transient elevation of the liver enzymes. Trans men reported an increase in sexual desire, voice instability, and clitoral pain (all P ≤ 0.01). Testosterone therapy increased acne scores, facial and body hair, and prevalence of androgenetic alopecia. Waist-hip ratio, muscle mass, triglycerides, total cholesterol (C), and LDL-C increased, whereas total body fat mass and HDL-C decreased. Three trans women experienced transient elevation of liver enzymes. A significant increase in breast tenderness, hot flashes, emotionality, and low sex drive was observed (all P ≤ 0.02). Fasting insulin, total body fat mass, and prolactin levels increased, and waist-hip ratio, lean mass, total C, and LDL-C decreased.


CONCLUSIONS
Current treatment modalities were effective and carried a low risk for side effects and adverse events at short-time follow-up.
Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
Katrien
K
Wierckx
Eva
E
Van Caenegem
Thomas
T
Schreiner
Ira
I
Haraldsen
Alessandra D
AD
Fisher
Alessandra
A
Fisher
Kaatje
K
Toye
Jean Marc
JM
Kaufman
Guy
G
T'Sjoen
D000328:Adult; D000726:Androgen Antagonists / Q000008:administration & dosage*; D000728:Androgens / Q000008:administration & dosage; D017373:Cyproterone Acetate / Q000008:administration & dosage*; D004958:Estradiol / Q000008:administration & dosage; D004967:Estrogens / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D012739:Gonadal Steroid Hormones / Q000008:administration & dosage*; D006801:Humans; D007328:Insulin / Q000378:metabolism; D050356:Lipid Metabolism; D008297:Male; D011446:Prospective Studies; D013739:Testosterone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014189:Transsexualism / Q000188:drug therapy*; D049629:Waist-Hip Ratio; D055815:Young Adult
D000726:Androgen Antagonists; D000728:Androgens; D004967:Estrogens; D012739:Gonadal Steroid Hormones; D007328:Insulin; D013739:Testosterone; D017373:Cyproterone Acetate; D004958:Estradiol; C010792:testosterone undecanoate
ENIGI; Gender Dysphoria; Hormone Treatment; Safety; Transsexualism