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Troubleshooting and FAQ for Transfeminine/Non-binary individuals on Feminising Treatment

  • Writer: Karen Impey
    Karen Impey
  • Oct 1
  • 2 min read

Routine Monitoring


Blood tests: Estradiol, SHBG, testosterone, U&E’s, LFT’s, Lipid profile including Triglycerides, and Prolactin should be done six monthly for a year and then annually.  Estradiol levels are ideally between 350-750 pmol/l if aged < 40; 300-600 pmol/l if aged 40-50; 200-400 pmol/l if aged > 50 or younger with significant CV risk factors particularly smoking or high BMI (> 40 kg/m2).


Hormones: If starting Estradiol over the age of 40 we would recommend conventional treatment for 10 years then reducing dosing down.  If started under the age of 40 we would recommend a dose reduction between 40-50 with an aim to tailing off and potentially stopping treatment between 60 and 70.  However, we would recommend an individualised approach should be employed after discussion with the individual regarding the risks and benefits.  If lower gender affirming surgery is not performed, we would recommend continuing a hormone blocker.


Mammograms: transwomen become eligible when they turn 50 for mammography on the breast screening programme.  If she continues to take estradiol after the age of 70, she should continue to attend the breast screening programme.  In addition, she should remain ‘breast aware’.


Prostate: If the patient develops any urological symptoms, consideration should also be given to the fact that she still has a prostate gland in situ.


Osteoporosis: There is no evidence for routine DEXA scanning in trans-feminine individuals. Trans-feminine individuals may have lower bone density than matched cis-males, but they are at no greater risk of osteoporosis than matched cis-females, provided that they have not had androgen blockade or gonadectomy without estradiol treatment. We would encourage an individualised approach to DEXA scanning based on the presence of other risk factors such as low BMI, corticosteroid use, alcohol excess or medical conditions associated with reduced BMD in line with national guidelines.

 

Other Considerations


Sexual health and Contraception:

–             FSRH: Contraceptive Choices and Sexual Health for Transgender and Non-Binary People: https://www.fsrh.org/documents/fsrh-ceu-statement-contraceptive-choices-and-sexual-health-for/


General health:



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You can contact the Gender Dysphoria National Referral Support Service by calling 0300 131 6775 or by emailing agem.gdnrss@nhs.net.

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