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Management of female-to-male transgender persons: medical and surgical management, life expectancy

Gooren, Louis J.

Current Opinion in Endocrinology & Diabetes and Obesity: June 2014 - Volume 21 - Issue 3 - p 233–238
doi: 10.1097/MED.0000000000000064
ANDROGENS: Edited by David Handelsman
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Purpose of review Hormonal treatment of transgender people is becoming a normal part of medicine, though numbers of subjects remain small because of low prevalence. Information on treatment is scattered and this review brings together the latest information on treatment goals and potential side-effects of androgen treatment of female-to-male transsexual subjects.

Recent findings Androgen treatment of female-to-male transsexuals is usually uneventful, with a good patient compliance. Goals of hormonal treatment are elimination of secondary sex characteristics of the female sex and induction of those of the male sex. Completion takes approximately 2 years. Hormonal treatment is eventually followed by surgical ablation of breasts and removal of uterus and ovaries. Phalloplasty may be considered. Concerns are the sequelae of hypogonadism following surgery, such as loss of bone mass. Contrary to earlier expectations, there is no increase in cardiovascular disease. (Hormone-related) cancers are rare, but vaginal, cervical, endometrial carcinomas have been reported. Cancers of the breasts are of greater concern and have been found in residual mammary tissue after breast ablation. So far, androgen treatment has not raised major safety concerns. Regrets about changing sex have not been reported.

Summary Testosterone treatment of female-to-male transsexuals is effective and well tolerated.

VU University Medical Center, Amsterdam, The Netherlands

Correspondence to Dr Louis J. Gooren, 72/1, moo 1, T.Palan, A.DoiSaket, Chiang Mai 50220, Thailand. Tel: +66 8 9612 7650; fax: +66 53 639 738; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins