RESUMO
Medical care for transgender patients is still characterized by an insufficient availability of healthcare services, as well as by poor provider education and training. Transgender patients often require gender-affirming hormone therapy (GAHT), and physicians, including endocrinologists, general practitioners, and others, should be trained to initiate and monitor these treatments throughout the transition process, and beyond. This article will address the specific issues surrounding GAHT in adult transgender women and men.
Title: Hormonothérapies de transition chez les personnes transgenres. Abstract: Aujourd'hui encore, la prise en charge médicale des personnes transgenres pâtit d'une insuffisance d'offre de soins et de formation des soignants. La mise en Åuvre d'une hormonothérapie est souvent souhaitée par les personnes transgenres et il est nécessaire qu'un médecin sache l'instaurer et la suivre tout au long de la transition. Nous abordons dans cette revue le traitement hormonal féminisant (THF) chez les femmes transgenres adultes, et le traitement hormonal masculinisant (THM) chez les hommes transgenres adultes.
Assuntos
Médicos , Pessoas Transgênero , Adulto , Masculino , Humanos , Feminino , Hormônios/uso terapêuticoRESUMO
RESEARCH QUESTION: The reproductive potential of transgender people may be impaired by gender-affirming hormone treatment (GAHT) and is obviously suppressed by gender-affirming surgery involving bilateral orchiectomy. The evolution of medical support for transgender people has made fertility preservation strategies possible. Fertility preservation in transgender women mainly relies on sperm cryopreservation. There are few studies on this subject, and the sample sizes are small, and so it difficult to know whether fertility preservation procedures are feasible and effective in trans women. DESIGN: This retrospective study reports the management of fertility preservation in transgender women referred to the study centre for sperm cryopreservation, and the semen parameters of trans women were compared with those of sperm donors. RESULTS: Ninety-six per cent of transgender women who had not started treatment benefitted from sperm cryopreservation, compared with 80% of those who attempted a therapeutic window and 50% of those receiving hormonal treatment at the time of sperm collection. No major impairment of semen parameters was observed in transgender women who had not started GAHT compared with sperm donors. However, even though the frequency of oligozoospermia was no different, two transgender women presented azoospermia. Some transgender women who had started GAHT could benefit from sperm freezing. None of them were treated with gonadotrophin-releasing hormone (GnRH) analogues. CONCLUSIONS: Parenthood strategies for transgender people have long been ignored, but this is an important issue to consider, especially because medical treatments and surgeries may be undertaken in adolescents or very young adults. Fertility preservation should ideally be offered prior to initiation of GAHT.
