E-Poster Presentation ESA-SRB-ANZBMS 2021

Gender affirming endocrine care at a victorian tertiary centre (#376)

Ryan Endall 1 2 , Madhuni Herath 1 2 3 , Rita Upreti 1 2 3 , Anna Watts 1 3 , Sarah Catford 1 2 4
  1. Department of Endocrinology, Monash Health, Melbourne
  2. Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research and Monash University, Melbourne
  3. Department of Diabetes and Endocrinology, Western Health, Melbourne
  4. Department of Endocrinology and Diabetes, Alfred Health, Melbourne

Background

Transgender and gender diverse (TGD) individuals are increasingly seeking gender-affirming care. Monash Health is one of the hospital providers for gender-affirming hormone therapy (GAHT) in Victoria. We present data from our clinic between January 2018-December 2020.

 

Results

173 new TGD clients were seen, mean age 27.5 years (range 17-59). The most prevalent baseline comorbidities were overweight/obesity (58% of those with recorded weight) depression/anxiety (44.5%), active or prior smoking history (33.5%), and autism spectrum disorder (8.7%).

 

120 (69.4%) individuals were referred for GAHT initiation. 54 (45%) commenced feminising and 44 (36.7%) commenced masculinising GAHT within six months of their initial clinic review; 22 (18.3%) did not commence GAHT, typically if individuals declined or baseline requirements (pathology, consent) were not completed.

Feminising GAHT formulations included combined oral contraceptive pill (COCP) (n = 23), oral oestradiol (n = 17), and transdermal oestradiol (n = 13). Androgen blockers, prescribed to 30 clients, were cyproterone acetate (CPA) (n = 21), or spironolactone (n = 9). Masculinising GAHT formulations were intramuscular (n = 24), transdermal (n = 19), and oral (n = 1) testosterone.

 

Of the 53 (30.6%) individuals referred for GAHT optimisation, 30 (56.6%) were already using feminising and 23 (43.4%) using masculinising GAHT. Feminising hormones included oral oestradiol (n = 17), COCP (n = 6), transdermal oestradiol (n = 3), and oestradiol implant (n = 1). 20 were using androgen blockers, including spironolactone (n = 15) and CPA (n = 5). Masculinising hormones included intramuscular (n = 20), transdermal (n = 2), or oral (n = 1) testosterone.

 

Discussion

Hormone therapy is an important part of gender-affirming care for many TGD individuals, and tertiary clinics provide an important service in the initiation and optimisation thereof. Further research is needed to inform evidence-based and individualised prescribing, particularly in the context of common comorbidities.