Treatment
12
Table 9. Baseline and Follow-up Protocol During Induction
of Puberty
Every 3–6 mo Anthropometry: height, weight, sitting height, blood pressure,
Tanner stages
Every 6–12 mo • In transgender males: hemoglobin/hematocrit, lipids,
testosterone, 25OH vitamin D
• In transgender females: prolactin, estradiol, 25OH vitamin D
Every 1–2 y • BMD using DXA
• Bone age on X-ray of the left hand (if clinically indicated)
BMD should be monitored into adulthood (until the age of 25–30 y or until peak
bone mass has been reached).
For recommendations on monitoring once pubertal induction has been completed,
see Tables 14 and 15.
Adapted from Hembree WC et al. J Clin Endocrinol Metab. 2009;94(9):3132–3154.
Table 10. Medical Risks Associated With Sex Hormone
Therapy
Transgender female: estrogen
Very high risk of adverse outcomes:
• Thromboembolic disease
Moderate risk of adverse outcomes:
• Macroprolactinoma
• Breast cancer
• Coronary artery disease
• Cerebrovascular disease
• Cholelithiasis
• Hypertriglyceridemia
Transgender male: testosterone
Very high risk of adverse outcomes:
• Erythrocytosis (hematocrit >50%)
Moderate risk of adverse outcomes:
• Severe liver dysfunction (transaminases >threefold upper limit of normal)
• Coronary artery disease
• Cerebrovascular disease
• Hypertension
• Breast or uterine cancer
