15
Adverse Outcome Prevention and Long-Term Care
➤ ES suggests regular clinical evaluation for physical changes and potential
adverse changes in response to sex steroid hormones and laboratory
monitoring of sex steroid hormone levels every 3 months during the first
year of hormone therapy for transgender males and females and then once
or twice yearly. (2|⊕⊕
)
➤ ES suggests periodically monitoring prolactin levels in transgender
females treated with estrogens. (2|⊕⊕
)
➤ ES suggests that clinicians evaluate transgender persons treated with
hormones for cardiovascular risk factors using fasting lipid profiles,
diabetes screening, and/or other diagnostic tools. (2|⊕⊕
)
➤ ES recommends that clinicians obtain bone mineral density (BMD)
measurements when risk factors for osteoporosis exist, specifically in
those who stop sex hormone therapy after gonadectomy. (1|⊕⊕
)
➤ ES suggests that transgender females with no known increased risk of
breast cancer follow breast-screening guidelines recommended for non-
transgender females. (2|⊕⊕
)
➤ ES suggests that transgender females treated with estrogens follow
individualized screening according to personal risk for prostatic disease
and prostate cancer. (2|⊕
)
➤ ES advises that clinicians determine the medical necessity of including a
total hysterectomy and oophorectomy as part of gender-affirming surgery.
(UGPS)
