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Brief Summary

Information for GPs regarding the use of masculinising hormone therapy in gender dysphoria. This guidance has been prepared and approved for use in Newcastle, North Tyneside and Northumberland in consultation with the Primary and Secondary Care NHS trusts.

Extract from Document

Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and
the associated gender role and/or primary and secondary sex characteristic). Transsexualism is the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make the individual’s body as congruent as possible with the preferred sex through surgery and hormone treatment (ICD-10 code F64.0).

Feminising or masculinising hormone therapy – the administration of exogenous endocrine agents to induce feminising or masculinising changes – is a medically necessary intervention for many transsexual, transgender, and gendernonconforming individuals with gender dysphoria.

The aim of hormone treatment for transgender people is to modify secondary sexual characteristics, so that the individual’s body is more in keeping with their gender identity, thus reducing the dysphoria and distress that they experience. In order to achieve this, hormones of the opposite biological sex are administered, sometimes in conjunction with medication to suppress endogenous sex hormone production. GnRH analogues are generally used in order to
achieve this.

Hormone therapy can provide significant comfort to people who experience gender dysphoria who do not wish to transition to a different gender role or undergo surgery, or who are unable to do so. Hormone therapy may be recommended for patients who do not want surgery following assessment following assessment and in accordance with UK standards (Good practice guidelines for the assessment and treatment of adults with gender dysphoria, Royal College of Psychiatrists, 2013). In some patients, hormone therapy alone may provide sufficient symptomatic relief to obviate the need for transition to a different gender role or surgery.

Not all these medicines used in this context are licensed for the treatment of gender dysphoria, nor are they likely to be. However, they are widely used medicines for other indications, which GPs will be familiar with. Hormone prescribing in this field under the guidance of a specialist service, has been shown to be safe and can be undertaken mainly in primary care. Accepting the desire for the guidelines to be evidence based, there is a great paucity of such evidence. Hormone support is based on traditional patterns of treatment. Hormone support in the Northern Region Gender Dysphoria Service is provided by a Multidisciplinary Team that includes advice from a specialist clinical endocrinologist.

Wherever possible, physiological end organ response is the aim of endocrine treatments. This is based on management of circulating hormone levels to allow
accurate and individual dose titration together with suppression of the hormone effects associated with the undesired gender. Treatment is flexible and patientled
as far as is consistent with clinical safety and with the agreement of the prescriber and taking account of the individual’s views of their needs.

Close liaison between the specialist clinician and GP is essential, as are physical assessment and ongoing haematological, endocrinological and biochemical monitoring. All patients receiving hormone therapies are regularly reviewed to ensure that clinical well-being is maintained. The service aims to see patients every 4 months in the first year of treatment and at least 6 monthly thereafter. Choice of hormone preparation, method of delivery and dosage is in line with current understanding of minimum health risks and maximum efficacy. The endocrine treatment protocols outlined below aim to deliver optimum results in
the safest way, and should be suitable for the majority of people. Where an individual has a medical condition that may impact on hormone treatment or vice
versa, the specialist clinician may request that the GP refers the patient to the regional specialist endocrinology service (contact details available at the end of this document).