Transgender Endocrinology

Transgender and gender-diverse people have a gender identity that differs from their gender implied by their sex assigned at birth. Many transgender and gender-diverse youth and adults have gender dysphoria, which is the discomfort and uneasiness of living in a gender role that is not consistent with their gender identity. Gender-affirming hormone therapy helps relieve this discomfort, helps align individuals’ gender identity with their external physical appearance, and improves quality of life. Transgender and gender-diverse youth should be evaluated by a multispecialty team to uncover any potential coexisting mental and medical health concerns and determine the eligibility and appropriate timing of gender-affirming hormone therapy. Transgender and gender-diverse adults should be evaluated for chronic medical conditions that can be exacerbated by hormone therapy. Transfeminine adults primarily receive estrogen and testosterone-lowering medications as part of gender-affirming hormone therapy. Transmasculine adults primarily receive testosterone. Some transgender and gender-diverse individuals may elect to have gender-affirming surgical procedures. Although gender-affirming hormone therapy appears safe in the short term, there are risks that should be monitored throughout treatment. There remains a gap in knowledge regarding the most efficacious hormone regimens for gender affirmation and long-term risks of hormone therapy. Other barriers include inadequate training of medical providers able to provide care for transgender and gender-diverse people and limited access to care. Long-term studies are needed to improve the safety and efficacy of pubertal suppression in eligible youth and of gender-affirming hormone therapy in both transgender and gender-diverse youth and adults.