Endocrine Treatment of Transsexual Persons – A Patient’s Guide

In 1923, the term transsexual was first used to describe persons who felt profound discomfort with their biological sex. Today, medical treatment, sometimes together with surgery, allows transsexual persons to make a male-to-female (MTF) or female-to-male (FTM) transition and to live a gender-appropriate life.

This is the patient guide that was released at the same time as the “Endocrine Treatment
of Transsexual Persons”.

Dated September 2009.

Endocrine Treatment of Transsexual Persons

The aim was to formulate practice guidelines for endocrine treatment of transsexual persons by medical practitioners, endocrinologists, surgeons, psychiatrists, and General Practitioners. This is the current version even though it is dated 2009.

First published in the Journal of Clinical Endocrinology & Metabolism, September 2009, 94(9): 3132–3154

UK Hormones 2005

A comprehensive document of 96 pages about hormonal regimes, the drugs used, their benefits, and their side-effects. Plus the emergency situations that they can cause. Updated, well indexed and with new content.

Update – I am currently rewriting this, and its provisional title is “Universal Hormones – 2015″, which should be published early in 2015.

UK Hormones 2005

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Everything You Ever Wanted To Know About Sex Change – But Were Afraid To Ask

by Melanie. Written by an American but contains interesting information, some of which may be out of date now.

Endocrinology Handbook, May 2010 – NEW

The most current update of the “Endocrinology Handbook”  published by the Imperial College Endocrine Unit, London.

Endocrinology Handbook 2010.

Available here for download 289.06 KB 69 downloads

A Guide To Hormone Therapy For Trans People

This booklet has been produced by a team that includes doctors and trans people to help you understand and answer some of your questions about hormone treatment for trans people. If you are thinking about starting hormone therapy, you may find it helpful to share the information in this booklet with a spouse or partner or other family members. Department of Health guidelines dated 2007.

Guidance For GPs, Other Clinicians And Health Professionals On The Care Of Gender Variant People

Gender variant people are relatively rarely seen in GP surgeries. Many GPs say that they lack the knowledge to treat those experiencing gender variant conditions and, consequently, they are not confident to do so. The first part of this publication provides an overview of care for trans people that is particularly applicable to GPs. Department of Health guidelines dated 2008.

NHS Funding Processes And Waiting Times For Adult Service-Users

This publication will help you understand the processes involved in obtaining funding for treatment for gender variant conditions. It answers the questions that service-users typically ask, and it provides guidance on how to navigate this complex system with minimum delay. Your GP may also find this information helpful. Department of Health guidelines dated 2008.

Standards Of Care For The Health Of Transsexual, Transgender, And Gender Nonconforming People – Version 7

This is the current version as used by the ‘The World Professional Association for Transgender Health’.

Nursing With Dignity

A guide to cultural and spiritual awareness, from various sources. This is Version 2 which is much improved.

Nursing with dignity

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Counselling Transgendered, Transsexual, And Gender-Variant Clients

A guide for counsellors from Journal of Counselling & Development 2002.

Clinical Conditions-v1.7

A guide to various different clinical conditions showing their signs and symptoms, and their treatment options.

Clinical conditions-v-1.7

Download 933.84 KB 841 downloads

UPDATED 11 December 2014

This is a radio programme first broadcast on BBC Three Counties Radio round about the end of June 2014.

Gender Dysphoria

Download Gender Dysphoria on the radio 33.74 MB 193 downloads

A radio programme broadcast on BBC Radio 4 on 12 December 2014.

A revealing series which goes inside the Charing Cross Gender Identity Clinic in Hammersmith, London – the largest and oldest in the world – to explore the condition of gender dysphoria. This programme discusses trans-men.

A radio programme broadcast on BBC Radio 4 on 19 December 2014.

The second in a two-part series, with this one covering trans-women.

Becoming myself 2

Download 26.55 MB 68 downloads

Becoming Myself: Gender Identity – 1

A radio programme broadcast on Radio 4 on 12 December 2014.  This is a mp3 file of 28MB size.

A revealing series which goes inside the Charing Cross Gender Identity Clinic in Hammersmith, London – the largest and oldest in the world – to explore the condition of gender dysphoria.


Incidence of breast cancer in a cohort of 5,135 transgender veterans.


Transgender (TG) persons often receive, or self-treat, with cross-sex hormone (CSH) treatments as part of their treatment plans, with little known about their incidence of breast cancer. This information gap can lead to disparities in the provision of transgender health care. The purpose of the study was to examine the incidence of breast cancer in the largest North American sample of TG patients studied to date to determine their exposure to CSH, incidence of breast cancer, and to compare results with European studies in transsexual populations. We used Veterans Health Administration (VHA) data from 5,135 TG veterans in the United States from 1996 to 2013 to determine the incidence of breast cancer in this population. Chart reviews were completed on all patients who developed breast cancer. Age-standardized incidences of breast cancer from the general population were used for comparison. Person-years of exposure to known CSH treatment were calculated. Ten breast cancer cases were confirmed. Seven were in female-to-male patients, two in male-to-female patients, and one in a natal male with transvestic fetishism. Average age at diagnosis was 63.8 (SD = 8.2). 52 % received >1 dose of CSH treatment from VHA clinicians. All three males presented with late-stage disease were proved fatal. The overall incidence rate was 20.0/100,000 patient-years of VHA treatment (95 % CI 9.6-36.8), irrespective of VA CSH treatment. This rate did not differ from the expected rate in an age-standardized national sample, but exceeded that reported for smaller European studies of transsexual patients that were longer in duration. Although definitive conclusions cannot be made regarding breast cancer incidence in TG veterans who did or did not receive VA CSH due to the sample size and duration of observation, it appears that TG veterans do not display an increase in breast cancer incidence. This is consistent with European studies of longer duration that conclude that CSH treatment in gender dysphoric patients of either birth sex does not result in a greater incidence than the general population.


Brown GR, Jones KT.


Breast Cancer Research and Treatment, 2014 Nov 27. [Epub ahead of print]

What this means to you.

The last sentence is the very important one, which essentially is saying that the risk of breast cancer is not increased by the hormone treatments that we receive.

Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men.


An association between testosterone therapy (TT) and cardiovascular disease has been reported and TT use is increasing rapidly.


We conducted a cohort study of the risk of acute non-fatal myocardial infarction (MI) following an initial TT prescription (N = 55,593) in a large health-care database. We compared the incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre). We also compared post/pre rates in a cohort of men prescribed phosphodiesterase type 5 inhibitors (PDE5I; sildenafil or tadalafil, N = 167,279), and compared TT prescription post/pre rates with the PDE5I post/pre rates, adjusting for potential confounders using doubly robust estimation.


In all subjects, the post/pre-prescription rate ratio (RR) for TT prescription was 1.36 (1.03, 1.81). In men aged 65 years and older, the RR was 2.19 (1.27, 3.77) for TT prescription and 1.15 (0.83, 1.59) for PDE5I, and the ratio of the rate ratios (RRR) for TT prescription relative to PDE5I was 1.90 (1.04, 3.49). The RR for TT prescription increased with age from 0.95 (0.54, 1.67) for men under age 55 years to 3.43 (1.54, 7.56) for those aged ≥75 years (ptrend = 0.03), while no trend was seen for PDE5I (ptrend = 0.18). In men under age 65 years, excess risk was confined to those with a prior history of heart disease, with RRs of 2.90 (1.49, 5.62) for TT prescription and 1.40 (0.91, 2.14) for PDE5I, and a RRR of 2.07 (1.05, 4.11).


In older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.


Finkle WD, Greenland S, Ridgeway GK, Adams JL, Frasco MA, et al. (2014) Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men. PLoS ONE 9(1): e85805.


January 29, 2014

What this means to you.

If you have heart disease and take testosterone there is an increased risk of a heart attack.

Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria.


Cross-sex hormonal treatment (CHT) used for gender dysphoria (GD) could by itself affect well-being without the use of genital surgery; however, to date, there is a paucity of studies investigating the effects of CHT alone.


This study aimed to assess differences in body uneasiness and psychiatric symptoms between GD clients taking CHT and those not taking hormones (no CHT). A second aim was to assess whether length of CHT treatment and daily dose provided an explanation for levels of body uneasiness and psychiatric symptoms.


A consecutive series of 125 subjects meeting the criteria for GD who not had genital reassignment surgery were considered.

Main outcome measures

Subjects were asked to complete the Body Uneasiness Test (BUT) to explore different areas of body-related psychopathology and the Symptom Checklist-90 Revised (SCL-90-R) to measure psychological state. In addition, data on daily hormone dose and length of hormonal treatment (androgens, estrogens, and/or antiandrogens) were collected through an analysis of medical records.


Among the male-to-female (MtF) individuals, those using CHT reported less body uneasiness compared with individuals in the no-CHT group. No significant differences were observed between CHT and no-CHT groups in the female-to-male (FtM) sample. Also, no significant differences in SCL score were observed with regard to gender (MtF vs. FtM), hormone treatment (CHT vs. no-CHT), or the interaction of these two variables. Moreover, a two-step hierarchical regression showed that cumulative dose of estradiol (daily dose of estradiol times days of treatment) and cumulative dose of androgen blockers (daily dose of androgen blockers times days of treatment) predicted BUT score even after controlling for age, gender role, cosmetic surgery, and BMI.


The differences observed between MtF and FtM individuals suggest that body-related uneasiness associated with GD may be effectively diminished with the administration of CHT even without the use of genital surgery for MtF clients. A discussion is provided on the importance of controlling both length and daily dose of treatment for the most effective impact on body uneasiness.


Fisher AD, Castellini G, Bandini E, Casale H, Fanni E, Benni L, Ferruccio N, Meriggiola MC, Manieri C, Gualerzi A, Jannini E, Oppo A, Ricca V, Maggi M, Rellini AH.


Journal of Sexual Medicine. March 2014; volume 11, number 3: pages 709-19.

Staying Sane and Whole While in Transition.

Tripping the Light Fantastic: Staying Sane and Whole While in Transition

by Dallas Denny

Sex reassignment is one of the most radical and disruptive things that an individual can do. It strains and often severs social relationships, imposes economic hardships, involves a good deal of physical pain and a great deal of psychic pain, and requires study and hard work in order to even begin to hope to pass in the gender of choice. Transition must be pursued in the face of the general disapproval of society and the specific disapproval of loved ones, the reluctance of the medical community to provide services, a scarcity of resources, and countless legal and social obstacles. The body of one sex must be somehow whipped into the semblance of that of the opposite sex, generally after puberty has wreaked irreversible somatic changes. Old behavioural patterns must be unlearned and new ones added. A new life must replace the old.

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