Guy G. T'Sjoen Vouches for Safety of Cross-Sex Hormone Treatment

Guy G. T’Sjoen, MD, PhD, is the head of Department of Endocrinology at Ghent University in Belgium and helped found the European Network for the Investigation of Gender Incongruence (ENIGI) initiative in 2010 to study health in transgender individuals. At ENDO 2017, he spoke of the data that exists regarding the safety and efficacy of hormone therapy for those transitioning.

T’Sjoen said he was aimless after high school until he saw Spanish director Pedro Almodóvar’s Law of Desire, which featured a transgender actress. Shortly thereafter, he registered for a medical education, and many years later upon meeting his first transgender endocrinology patient, he realized how little medical knowledge there was of the population.

He gave the room the respect to not define “transgenderism” again to them, saying it would be like “explaining diabetes to a room of endocrinologists.”

Based on the research done already, T’Sjoen ran through available short and mid-term study data about hormone treatment for transition, noting that true long term data remains scarce given that such research is hardly a few decades old.

In the short term, there were notable effects on both trans men (female to male) and trans women (male to female) as their bodies adjusted to the hormone treatment. For transgender women, breast tenderness, low sexual desire, emotionality and hot flashes are common. For transgender men, clitoral pain and increased sexual desire are typically noted, in addition to acne that can be at-times severe, peaking at about 6 months after treatment initiation.

Virilization and feminization both take time, he said, and elevating hormone treatment because of limited initial results was not recommended.

In the mid-term, potential risks elevate, but not to a critical level. For trans women, an increased risk of thromboembolism may occur, in addition to depression and osteoporosis. He cited a study linking estrogen treatment for transitioning women with a 16% increase in cases of osteoporosis, with no equivalent finding for transitioning men on testosterone. For transgender women, there was an uptick in cardiovascular risk, but not cardiovascular morbidity.

“I’ve had a lot of discussions with colleagues over the years who are opposed to hormone treatment in transgender people,” he said, “At the end of such a discussion they always refer to the possible breast cancer risk that you may induce in trans women. Well, we have an answer for that too,” he said, before introducing a recent study in over 5,000 military veterans that found no increase in the chance of breast cancer in transgender women against an age and sex matched control population.

T’Sjoen seemed determined to counter most potential health risks with studies that minimized them, and has a particular passion for the cause of that. There are astronomical suicide attempt rates among transgender individuals around the world, and he championed a well-respected 2016 study published in the Journal of Clinical Endocrinology and Metabolism that found hormone treatment for transgender individuals produced extremely significant psychological benefits for them. To that, he said hormone treatment “is easy, is safe, and it saves lives.”

He began his clinic at Ghent in 2000, and says that year he saw only about 25 new transgender patients. In 2016, the number of new faces was 300. The barriers blocking transgender individuals appear to be melting, he says, to explain the noticeable increase.

“Those 300 that I saw last year are just the tip of the iceberg,” he added, “Basically, there are two blind spots: one, we don’t know how many transgender people really are, and two, how many experience a need for medical health care.”

Not long after T’Sjoen spoke, the openly transgender Physician General of Pennsylvania, Rachel Levine, MD, took the stage to discuss her experience. She received loud applause on noting that she had been unanimously approved by a relatively conservative Pennsylvania State Senate: “They were able to look only at my professional qualifications, which is the way it should be,” she said. She joked, though, that her biggest transition had been moving from her job at Mount Sinai in Manhattan to her next position in central Pennsylvania.