Complications
Both oestrogens and androgens increase appetite, so unless actual consumption is kept constant, weight gain will result.
Oestrogen treatment raises the risk of thromboembolic disease, particularly in smokers.[31] Non-smoking status should be strongly recommended prior to treatment. For those with non-modifiable risk factors which may increase the risk of thromboembolic disease, e.g. a known history of thrombophilia, a past history of thrombosis, or a strong family history of thromboembolism, offering an anticoagulant in addition to treatment with transdermal oestrogen may decrease the risk of thromboembolism, although data to guide treatment decisions are extremely limited.[4]
Particularly before hysterectomy and oophorectomy, when higher doses of androgens may sometimes be employed to achieve menopause.
The American College of Obstetricians and Gynaecologists list polycythaemia (haematocrit greater than 55%) as an absolute contraindication to testosterone treatment.[44]
Androgen treatment raises haematocrit, particularly in smokers. Hysterectomy and oophorectomy may allow dose reduction, or phlebotomy may be needed.[57]
Particularly at outset of treatment.
Oestrogens and androgens can cause prolactin to rise. Only levels of over 1000 IU require endocrine advice.[57]
Dyslipidaemia is not common, but is worthwhile monitoring. If apparent it is treated in the usual manner with diet and statins.
Bone mass is generally preserved with use of either sex steroid. The risk of osteoporosis is increased for patients who stop sex hormone treatment following gonadectomy.[31] Screening for osteoporosis is recommended for patients with risk factors, and in particular for those who stop hormone treatment following gonadectomy.[31]
Trangender people are at increased risk for mental health problems, including suicidal ideation, prior to gender-affirming treatment and legal gender change. This risk may persist after gender reassignment if the individual struggles to adjust.[2] Furthermore, a number of external social factors including stigma, discrimination, and minority stress have been suggested as contributing factors.[15] Primary care screening and assessment for mental health conditions is likely to be valuable on an ongoing basis.
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