Publicação
Complicações associadas à Terapêutica Hormonal de Afirmação de Género
| Resumo: | Health care within the scope of gender affirmation includes gender-affirming hormonal therapy (THAG), whose main objective is to achieve physiological levels of sexual hormones associated with the individual's desired gender. Therapeutic regimes may include suppression of the secretion of endogenous sex hormones (with analogues of gonadotropin-releasing hormone - aGnRH), the administration of exogenous sex hormones, or the combination of both strategies. In feminizing therapy, estrogens and antiandrogens are mainly used; testosterone esters are used in masculinizing therapy. THAG carries possible risks of complications, including cardiovascular, oncological, on fertility, bone and psychiatric complications. Based on this fact, this narrative review aims to evaluate the evidence and identify the most prevalent potential complications and gather useful conclusions for informed and updated clinical practice.A search was carried out in the PubMed database, which included publications dated from 2013 to 2023. Each reference was evaluated based on the abstract, in order to select it for later full reading and, after analysis, inclusion in this review.The literature highlights the cardiovascular effects, namely the risk of thromboembolic events with estrogen therapy, which appears to be dose-dependent and variable according to the route of hormonal administration; the risk of erythrocytosis in testosterone therapy; and the emergence of hyperprolactinemia and meningiomas with high doses of the antiandrogen cyproterone acetate. The results do not show an increased risk of developing hormone-dependent neoplasms or a significant impact on the reproductive potential of transgender individuals, but there are gaps in understanding the long-term effects. THAG is also considered safe at the bone level. Finally, the impact on individuals’ mental and sexual health, and quality of life is globally positive.A multidisciplinary and individualized approach ensures the safety and effectiveness of gender-affirming hormonal therapy. Adequate monitoring, combined with the maintenance of serum hormone levels within the intended physiological ranges, and the adjustment of hormonal regimens in terms of dose and routes of administration in accordance with the most recent recommendations, shows that complications have become less prevalent and less significant. The need for future prospective longitudinal studies is highlighted, in order to better understand the long-term effects of these hormonal therapies. |
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| Autores principais: | Fernandes, Jessica Filipa Miranda |
| Assunto: | transgender therapy hormones complications transgénero terapêutica hormonas complicações |
| Ano: | 2024 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Coimbra |
| Idioma: | português |
| Origem: | Estudo Geral - Universidade de Coimbra |
| Resumo: | Health care within the scope of gender affirmation includes gender-affirming hormonal therapy (THAG), whose main objective is to achieve physiological levels of sexual hormones associated with the individual's desired gender. Therapeutic regimes may include suppression of the secretion of endogenous sex hormones (with analogues of gonadotropin-releasing hormone - aGnRH), the administration of exogenous sex hormones, or the combination of both strategies. In feminizing therapy, estrogens and antiandrogens are mainly used; testosterone esters are used in masculinizing therapy. THAG carries possible risks of complications, including cardiovascular, oncological, on fertility, bone and psychiatric complications. Based on this fact, this narrative review aims to evaluate the evidence and identify the most prevalent potential complications and gather useful conclusions for informed and updated clinical practice.A search was carried out in the PubMed database, which included publications dated from 2013 to 2023. Each reference was evaluated based on the abstract, in order to select it for later full reading and, after analysis, inclusion in this review.The literature highlights the cardiovascular effects, namely the risk of thromboembolic events with estrogen therapy, which appears to be dose-dependent and variable according to the route of hormonal administration; the risk of erythrocytosis in testosterone therapy; and the emergence of hyperprolactinemia and meningiomas with high doses of the antiandrogen cyproterone acetate. The results do not show an increased risk of developing hormone-dependent neoplasms or a significant impact on the reproductive potential of transgender individuals, but there are gaps in understanding the long-term effects. THAG is also considered safe at the bone level. Finally, the impact on individuals’ mental and sexual health, and quality of life is globally positive.A multidisciplinary and individualized approach ensures the safety and effectiveness of gender-affirming hormonal therapy. Adequate monitoring, combined with the maintenance of serum hormone levels within the intended physiological ranges, and the adjustment of hormonal regimens in terms of dose and routes of administration in accordance with the most recent recommendations, shows that complications have become less prevalent and less significant. The need for future prospective longitudinal studies is highlighted, in order to better understand the long-term effects of these hormonal therapies. |
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