12. Guidelines
• As the comfort with the topic
increases, there is greater trusting
of the patient
• Strong movement to create
treatment paradigms that are
reproducible by practitioners in
multiple specialties
13. In some ways female is the default –
--- with the degree of androgen action key
--- M to F - Testo in female range;
E2 not supraphysiologic
--- F to M - Testo in male range
Guidelines: goals are plainly stated:
17. Androgens – injectable
----- testosterone (cypionate or
enanthate) 100 mg (IM or SQ)
every week for 70kg ideal weight.
Androgens – other
----- transdermal (gel or patch)
5-10 g every day.
------ implantable
“levels vs needles”
“levels vs details and irritation”
18. For F to M, follow T and
androgen sensitive indexes
Female to male:
Follow
- serum testosterone
- Hct (or Hgb)
- lipid profile
Don’t neglect Pap smears,
mammograms etc.
25. Progestins: -- what’s the logic?
Lowers testosterone
Anecdotal reference to areola
Most data support modest virilization
Logic woman w/ uterus
Concern for post-menopausal woman
31. Estrogens– oral
----- estradiol 2-6 mg/day.
----- conjugated estrogens 2.5-7.5
mg/day
----- ethinyl estradiol - thromboses.
----- other (e.g. “bio-equivalent”)
quality control
ease, cost, horses vs lab
32. estrogens– injectable
----- estradiol valerate 5-20 mg IM
every 1-2 weeks.
estrogens– other
----- transdermal (gel or patch)
every day. (may have role for
trans-men)
------ implantable
33. Male to female:
Follow
- serum testosterone
- estrogen level
- prolactin
- K
- lipid profile
Don’t neglect prostate
For M to F, follow T, estrogen
sensitive indexes, and K
39. 1.0 Diagnosis
• 1.1 Mental health provider (xx, 1)
• 1.2 Do not Rx pre-pubertal children (xx, 1)
• 1.3 Discuss impact of Rx with pt, parents
• 1.4 Discuss fertility
40. 3.0 Rx of Adults
• 3.1 Endo to confirm dx per criteria (xxx, 1)
• 3.2 Medical assessment for Rx risk (xxx, 1)
• 3.3 Goal is range for target gender (xx, 2)
• 3.4 Review time-course for changes (xx, 2)
41. 4.0 Adverse Outcomes
and their Prevention
• 4.1 Monitor q 3 mos, then 2x/year (xx, 2)
• 4.2 Monitor prolactin for estrogen Rx (xx, 2)
• 4.3 CAD RF assessment (xx, 2)
• 4.4 BMD especially if osteoporosis risk (xxx, 2)
• 4.5 breast screen per age, FH (xx, 2)
• 4.6 prostate screen per age (x, 2)
• 4.7 F to M consider surgery for CA risk (x, 2)
