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Table 15. Monitoring of Transgender Persons on Gender-
Affirming Hormone Therapy: Transgender Female
1. Evaluate patient every 3 mo in the first year and then one to two times per year
to monitor for appropriate signs of feminization and for development of adverse
reactions
2. Measure serum testosterone and estradiol every 3 mo:
a. Serum testosterone levels should be <50 ng/dL
b. Serum estradiol should not exceed the peak physiologic range: 100–200 pg/mL
3. For individuals on spironolactone, serum electrolytes, particularly potassium, should
be monitored every 3 mo in the first year and annually thereafter
4. Routine cancer screening is recommended, as in nontransgender individuals (all
tissues present)
5. Consider BMD testing at baseline. In individuals at low risk, screening for
osteoporosis should be conducted at age 60 years or in those who are not compliant
with hormone therapy.
is table presents strong recommendations and does not include lower level recommendations.
