Hormone therapy: Difference between revisions

Puberty blockers are drugs that postpone or temporarily suspend puberty in children and teenagers. They are used for [[transgender]] children, including those who identify as [[nonbinary]], to stop the development of features that they consider to mark the wrong sex,<ref name=":0">{{Cite journal|last=Stevens|first=Jaime|last2=Gomez-Lobo|first2=Veronica|last3=Pine-Twaddell|first3=Elyse|date=2015-12-01|title=Insurance Coverage of Puberty Blocker Therapies for Transgender Youth|url=http://pediatrics.aappublications.org/content/136/6/1029|journal=Pediatrics|language=en|volume=136|issue=6|pages=1029–1031|doi=10.1542/peds.2015-2849|issn=0031-4005|pmid=26527547|doi-access=free}}</ref><ref>{{cite web |url=http://www.washingtontimes.com/news/2016/mar/12/looking-at-suppressing-puberty-for-transgender-kid/ |title=Looking at suppressing puberty for transgender kids |publisher=Associated Press |date=March 12, 2016}}</ref><ref>{{cite web |url=https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/ |title=Transgender Youth Using Puberty Blockers |publisher=[[KQED]] |date=August 19, 2016}}</ref> with the intent to provide transgender youth more time to explore their identity.<ref name=":1">{{Cite journal|last=Alegría|first=Christine Aramburu|date=2016-10-01|title=Gender nonconforming and transgender children/youth: Family, community, and implications for practice|journal=Journal of the American Association of Nurse Practitioners|language=en|volume=28|issue=10|pages=521–527|doi= 10.1002/2327-6924.12363|pmid=27031444|issn=2327-6924}}</ref> the studies that have been conducted indicate that these treatments are reasonably safe, and can improve psychological well-being in these individuals.<ref name="lancet_pubertyblockers">{{cite journal | last=Mahfouda | first=Simone | last2=Moore | first2=Julia K | last3=Siafarikas | first3=Aris | last4=Zepf | first4=Florian D | last5=Lin | first5=Ashleigh | title=Puberty suppression in transgender children and adolescents | journal=The Lancet Diabetes & Endocrinology | publisher=Elsevier BV | volume=5 | issue=10 | year=2017 | issn=2213-8587 | doi=10.1016/s2213-8587(17)30099-2 | pmid=28546095 | pages=816–826 | ref=harv|quote=The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."}}</ref><ref>{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |accessdate=23 July 2019|quote=Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free }}</ref><ref name="Hembree_et_al">{{cite journal |last1=Hembree |first1=Wylie C |last2=Cohen-Kettenis |first2=Peggy T |last3=Gooren |first3=Louis |last4=Hannema |first4=Sabine E |last5=Meyer |first5=Walter J |last6=Murad |first6=M Hassan |last7=Rosenthal |first7=Stephen M |last8=Safer |first8=Joshua D |last9=Tangpricha |first9=Vin |last10=T'Sjoen |first10=Guy G |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=November 2017 |volume=102 |issue=11 |page=3881|quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains|doi=10.1210/jc.2017-01658 |pmid=28945902 |doi-access=free }}</ref> In 2019, a study in the journal ''Pediatrics'' found that access to pubertal suppression during adolescence was associated with a lower odds of lifetime suicidality among transgender people.<ref>{{cite journal |last1=Turban |first1=Jack |title=Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation |journal=Pediatrics |date=February 2020 |volume=145 |issue=2 |page=e2019172 |doi=10.1542/peds.2019-1725 |pmid=31974216 |url=https://pediatrics.aappublications.org/content/145/2/e20191725 |accessdate=11 February 2020|pmc=7073269 }}</ref>

* Progestogens: a high dose of progestogens will decrease testosterone levels by a 70% to 80%, which is a significant decrease (albeit not in the average female range).<ref>{{Cite journal|last=Kjeld|first=J. M.|last2=Puah|first2=C. M.|last3=Kaufman|first3=B.|last4=Loizou|first4=S.|last5=Vlotides|first5=J.|last6=Gwee|first6=H. M.|last7=Kahn|first7=F.|last8=Sood|first8=R.|last9=Joplin|first9=G. F.|date=November 1979|title=EFFECTS OF NORGESTREL AND ETHINYLOESTRADIOL INGESTION ON SERUM LEVELS OF SEX HORMONES AND GONADOTROPHINS IN MEN|url=http://doi.wiley.com/10.1111/j.1365-2265.1979.tb03102.x|journal=Clinical Endocrinology|language=en|volume=11|issue=5|pages=497–504|doi=10.1111/j.1365-2265.1979.tb03102.x|issn=0300-0664}}</ref> This is less than GnRH analogues, which can decrease circulating testosterone levels by 95%.<ref>{{Cite book|url=http://site.ebrary.com/id/10014662|title=Urotext-Luts: Urology. Vol. 3 Vol. 3|date=2001|publisher=Urotext|isbn=978-1-903737-03-3|location=Blackrock|language=English|oclc=697776940}}</ref>

* Selective estrogen receptor modulators (SERMs) will reduce bone density loss and osteoporosis risk. However SERMs will also increase testosterone production in AMAB bodies with low T production (not taking into account HRT).<ref>{{Cite journal|last=Trost|first=Landon W.|last2=Khera|first2=Mohit|date=July 2014|title=Alternative Treatment Modalities for the Hypogonadal Patient|url=http://link.springer.com/10.1007/s11934-014-0417-2|journal=Current Urology Reports|language=en|volume=15|issue=7|pages=417|doi=10.1007/s11934-014-0417-2|issn=1527-2737}}</ref>

* A low-dose estrogen supplement is much safer than SERMs, but the dose required to avoid bone density loss is enough to cause full feminisation.<ref>{{Cite journal|last=Hadji|first=P.|last2=Colli|first2=E.|last3=Regidor|first3=P.-A.|date=December 2019|title=Bone health in estrogen-free contraception|url=http://link.springer.com/10.1007/s00198-019-05103-6|journal=Osteoporosis International|language=en|volume=30|issue=12|pages=2391–2400|doi=10.1007/s00198-019-05103-6|issn=0937-941X}}</ref>

* Topical non-aromatisable androgens (i.e. that can't be converted into an estrogen) applied to the breast will also block breast development, but they are not as effective as SERMs. There is also a risk of the androgen being distributed to other parts of the body and therefore causing masculinisation elsehwere.<ref>{{Cite journal|last=Kuhn|first=J-M.|last2=Roca|first2=R.|last3=Laudat|first3=Marie-Hélène|last4=Rieu|first4=M.|last5=Luton|first5=J-P.|last6=Bricaire|first6=H.|date=October 1983|title=STUDIES ON THE TREATMENT OF IDIOPATHIC GYNAECOMASTIA WITH PERCUTANEOUS DIHYDROTESTOSTERONE|url=http://doi.wiley.com/10.1111/j.1365-2265.1983.tb00026.x|journal=Clinical Endocrinology|language=en|volume=19|issue=4|pages=513–520|doi=10.1111/j.1365-2265.1983.tb00026.x|issn=0300-0664}}</ref>

* Exposing the breasts to radiation is an irreversible process that might block breast development, although it's not as effective as SERMs.<ref>{{Cite journal|last=Viani|first=Gustavo Arruda|last2=Bernardes da Silva|first2=Lucas Godói|last3=Stefano|first3=Eduardo Jose|date=July 2012|title=Prevention of Gynecomastia and Breast Pain Caused by Androgen Deprivation Therapy in Prostate Cancer: Tamoxifen or Radiotherapy?|url=https://linkinghub.elsevier.com/retrieve/pii/S0360301612000806|journal=International Journal of Radiation Oncology*Biology*Physics|language=en|volume=83|issue=4|pages=e519–e524|doi=10.1016/j.ijrobp.2012.01.036}}</ref> This treatment may increase the risk of breast cancer.<ref>{{Cite journal|last=Aksnessæther|first=Bjørg Y.|last2=Solberg|first2=Arne|last3=Klepp|first3=Olbjørn H.|last4=Myklebust|first4=Tor Åge|last5=Skovlund|first5=Eva|last6=Hoff|first6=Solveig Roth|last7=Vatten|first7=Lars J.|last8=Lund|first8=Jo-Åsmund|date=May 2018|title=Does Prophylactic Radiation Therapy to Avoid Gynecomastia in Patients With Prostate Cancer Increase the Risk of Breast Cancer?|url=https://linkinghub.elsevier.com/retrieve/pii/S0360301618302207|journal=International Journal of Radiation Oncology*Biology*Physics|language=en|volume=101|issue=1|pages=211–216|doi=10.1016/j.ijrobp.2018.01.096}}</ref>

It's worth noting that most AMAB people will not experience a marked breast development regardless of medication. Likewise, breast development will stop and might even withdraw if the treatment is stopped.<ref>{{Cite book|url=https://linkinghub.elsevier.com/retrieve/pii/B9780323359559000076|title=The Breast|last=Mancino|first=Anne T.|last2=Young|first2=Zachary T.|last3=Bland|first3=Kirby I.|date=2018|publisher=Elsevier|isbn=978-0-323-35955-9|pages=104–115.e5|language=en|doi=10.1016/b978-0-323-35955-9.00007-6}}</ref>

Periods are often a source of [[Gender dysphoria|dysphoria]] for [[AFAB]] nonbinary people. There are several ways of preventing them:<ref>{{Cite journal|last=Carswell|first=Jeremi M.|last2=Roberts|first2=Stephanie A.|date=December 2017|title=Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents|url=http://www.liebertpub.com/doi/10.1089/trgh.2017.0021|journal=Transgender Health|language=en|volume=2|issue=1|pages=195–201|doi=10.1089/trgh.2017.0021|issn=2380-193X|pmc=PMC5684657|pmid=29142910}}</ref>