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Progress on the road to better medical care for transgender patients

Gardner, Ivy H.; Safer, Joshua D.

Current Opinion in Endocrinology & Diabetes and Obesity: December 2013 - Volume 20 - Issue 6 - p 553–558
doi: 10.1097/

Purpose of review In order to improve transgender individuals’ access to healthcare, primary care physicians and specialists alike should be knowledgeable about transgender medicine. This review is intended to provide concise transgender hormone treatment guidelines.

Recent findings Transgender individuals report that the lack of knowledgeable providers represents the greatest barrier to transgender medical care. Hormone treatments are generally well tolerated and greatly benefit transgender patients. After physicians recognize that gender identity is stable, hormone treatments for transgender patients are often straightforward.

A practical target for hormone therapy for transgender men (female to male) is to increase testosterone levels to the normal male physiological range (300–1000 ng/dl) by administering testosterone. A practical target for hormone therapy for transgender women (male to female) is to decrease testosterone levels to the normal female range (30–100 ng/dl) without supra-physiological levels of estradiol (<200 pg/ml) by administering an antiandrogen and estrogen. Patients should be monitored every 3 months for the first year and then every 6–12 months for hormonal effects.

Summary Although more studies are required, recently published transgender medical treatment guidelines provide a good start toward making care of transgender patients more generalized and accessible to healthcare providers.

Section of Endocrinology, Boston University School of Medicine, Boston, Massachusetts, USA

Correspondence to Joshua D. Safer, MD, Endocrinology, Room M-1016, Boston University School of Medicine, 715 Albany Street, Boston, MA 02118, USA. Tel: +1 617 414 5634; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins