Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management

healthtransgenderwomenkapak

ESTROGEN AND ANTIANDROGEN HORMONE TREATMENT PROCESS IN TRANSGENDER WOMEN

Bekir Gülaç

Düzce University, Faculty of Medicine, Department of Gynecology and Obstetrics, Düzce, Türkiye

Gülaç B. Estrogen and Antiandrogen Hormone Treatment Process in Transgender Women. Balsak D, Aksin Ş, eds. Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.3-10.

ABSTRACT

For transgender women, achieving a feminine physical appearance and living as a woman in society hold significant importance. Hormonal therapy plays a pivotal role in developing secondary sex characteristics. Therefore, during the transition from male to transgender woman, the administration of estrogens and antiandrogens at appropriate doses and in suitable treatment regimens is essential to achieve the desired hormone balance. Hormone therapy functions by suppressing endogenous male sex hormone levels and replacing them with hormones aligned with a transgender woman’s identity. Treatment options include oral estrogens, transdermal estradiol patches, and injectable forms such as estradiol valerate or estradiol cypionate. However, physiological doses of estrogen alone are often insufficient to reduce androgen levels to ranges typical for cisgender women. To address this, antiandrogens are commonly prescribed to effectively lower testosterone levels. Commonly used antiandrogens include cyproterone acetate, spironolactone, finasteride, and gonadotropin-releasing hormone agonists, each offering distinct advantages and disadvantages depending on their mechanism of action, route of administration, and bioavailability.

These treatments carry potential risks, such as deep vein thrombosis and thromboembolic diseases. Therefore, treatment plans should be individualized, with thorough risk assessments and periodic monitoring of hormone levels. Pre-treatment evaluations, regular medical follow-ups, and routine screenings are essential to ensure safety and efficacy. Individuals using spironolactone require serum electrolyte monitoring, while routine cancer screenings and osteoporosis assessments are also recommended. Osteoporosis screening should begin at age 60 or earlier for individuals unable to maintain effective hormone therapy.

This study aims to evaluate the effects of estrogen and antiandrogen therapies in transgender women and highlight critical considerations for their follow-up care.

Keywords: Transgenderism; Estrogen replacement; Estrogenic agents; Antiandrogens; Precision medicine

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