Assessment of Hormone Eligibility and Readiness Ad

EndocrineTherapyforTransgenderAdultsinBritishColumbia:SuggestedGuidelinesPhysicalAspectsofTransgenderEndocrineTherapyMarshallDahl,M.D.,Ph.D.,F.R.C.P.C.*JamieL.Feldman,M.D.,Ph.D.†JoshuaGoldberg‡AfshinJaberi,B.Sc.(Pharm),R.Ph.§AssessmentofHormoneEligibilityandReadinessWalterBockting,Ph.D.†GailKnudson,M.D.,M.P.E.,F.R.C.P.C.**JoshuaGoldberg‡January2006acollaborationbetweenTranscendTransgenderSupport&EducationSocietyandVancouverCoastalHealth’sTransgenderHealthProgram,withfundingfromtheCanadianRainbowHealthCoalition’sRainbowHealth–ImprovingAccesstoCareinitiative*DepartmentofMedicine,UniversityofBritishColumbia,Vancouver,BC,Canada†DepartmentofFamilyMedicineandCommunityHealth,UniversityofMinnesota,Minneapolis,MN,USA‡TransgenderHealthProgram,Vancouver,BC,Canada§ReachCommunityHealthCentre,Vancouver,BC,Canada**DepartmentofSexualMedicine,UniversityofBritishColumbia/VancouverHospital,Vancouver,BC,CanadaPageiAcknowledgementsProjectcoordinatorsJoshuaGoldberg,DonnaLindenberg,andRodneyHuntResearchassistantsOliviaAshbeeandA.J.SimpsonReviewersPhysicalAspectsofTransgenderEndocrineTherapyRosemaryBasson,MD,PhD,FRCPCStacyElliott,MDVancouver,BC,CanadaVancouver,BC,CanadaFionnaBayleyLucretiavandenBerg,MD,FRCPCVancouver,BC,CanadaVictoria,BC,CanadaTrevorCorneil,MD,MHSc,CCFPMichaelvanTrotsenburg,MDVancouver,BC,CanadaAmsterdam,TheNetherlandsAssessmentofHormoneEligibilityandReadinessAdaptedfromCounsellingandMentalHealthCareofTransgenderAdultsandLovedOnesLinFraser,EdD,MFTHershelT.Russell,MA,MEd(c)SanFrancisco,CA,USAToronto,ONT,CanadaMeladyPreece,PhDSandraL.Samons,PhD,DCSWVancouver,BC,CanadaAnnArbor,MI,USARupertRaj,MAJulianYoung,PhD,RCCToronto,ONT,CanadaVictoria,BC,CanadaOliverRobinow,MD,FRCPCVancouver,BC,Canada©2006VancouverCoastalHealth,TranscendTransgenderSupport&EducationSociety,andtheCanadianRainbowHealthCoalitionThispublicationmaynotbecommerciallyreproduced,butcopyingforeducationalpurposeswithcreditisencouraged.ThismanualispartofasetofclinicalguidelinesproducedbytheTransCareProject,ajointinitiativeofTranscendTransgenderSupport&EducationSocietyandVancouverCoastalHealth’sTransgenderHealthProgram.WethanktheCanadianRainbowHealthCoalitionandVancouverCoastalHealthforfundingthisproject.CopiesofthismanualareavailablefordownloadfromtheTransgenderHealthProgramwebsite:http://www.vch.ca/transhealth.Updatesandrevisionswillbemadetotheonlineversionperiodically.Formoreinformationortocontributeupdates,pleasecontact:TransgenderHealthProgram#301-1290HornbyStreetVancouver,BCCanadaV6Z1W2Tel/TTY/TDD:604-734-1514or1-866-999-1514(toll-freeinBC)Email:[e-mail]:http://www.vch.ca/transhealthPageiiTableofContentsIntroductoryComments..................................................................................................................................iiiPhysicalAspectsofTransgenderEndocrineTherapy..................................................................................A-1ResponsibilitiesofthePrescribingClinician............................................................................................A-1Male-to-Female(MTF)EndocrineTherapy.............................................................................................A-2Mechanismsofaction........................................................................................................................A-2Expectedfeminizingeffects...............................................................................................................A-2Recommendedfeminizingregimen...................................................................................................A-3Alternativeregimensandagents.......................................................................................................A-4AssessmentpriortoinitiatingMTFendocrinetherapy.......................................................................A-6MonitoringrecommendationsfollowinginitiationofMTFendocrinetherapy.....................................A-6Female-to-Male(FTM)Therapy..............................................................................................................A-8Mechanismsofaction........................................................................................................................A-8Expectedmasculinizingeffects.........................................................................................................A-8Recommendedmasculinizingregimen..............................................................................................A-8Alternativeregimensandagents.....................................................................................................A-10AssessmentpriortoinitiatingFTMendocrinetherapy.....................................................................A-10MonitoringrecommendationsfollowinginitiationofFTMendocrinetherapy...................................A-11SummaryofLaboratoryInvestigations..................................................................................................A-12AssessmentofHormoneEligibilit