Treatment for Transgender

At our clinic, we follow international guidelines rather than Japanese ones.

★Transgender women (MtoF)

Key points: In Japan, many people use injections, but worldwide, oral or patch medications are the norm and injections are rarely used. The biggest reason is that injections do not stabilize the levels of female hormones in the blood. Therefore, our clinic focuses on oral or patch medications, and injections are the exception to the rule. Also, (for some reason) in Japan, some people use injections of progesterone, but progesterone is not necessary for people without a uterus.

◆Prescription examples:

#1 Estradiol (oral medication) 4-14 tablets/day (2mg-7mg)
#2 Estrana Tape 0.72mg (patch medication) 1-3 sheets every 2 days
#3 Progynon Depot 10mg (injection medication) 1-2V once every 1-2 weeks (2,000yen/V)

#4 Spironolactone 50mg 2-4 tablets/day (can be used in combination with any of the above #1, #2, or #3)

◆Ideal hormone levels:

– Blood estrogen (E2) concentration: 95-200pg/mL (350-750pmol/L)
– Blood testosterone concentration: 0.3-1.0ng/mL (30-100ng/dL)(*Ref.#3)

〇test fee
estrogen (E2): 2,200yen
testosterone: 1,800yen
estrogen (E2)+testosterone: 3,900yen

◆Other test items

・Blood prolactin concentration: less than 18.8ng/mL (400mU/L)
(Note: When transwomen receive hormone therapy, blood prolactin concentration may rise)
・d-dimer: Check when blood clots are suspected as a side effect of hormone drugs
・Liver function, kidney function, blood pressure, blood glucose, HbA1C, triglycerides, etc.
・Thyroid function: Perform as needed
・Breast ultrasound (breast cancer test): Perform as needed
・STD tests: Perform as needed

◆Possible side effects

Thrombosis, liver dysfunction, breast cancer, hyperlipidemia, etc.

★Trans men (FtoM)

Point: Unlike trans women (MtoF), oral medications are ineffective. It is possible to prescribe imported topical medications, but they are too expensive and not practical. Therefore, injections are recommended.

◆Prescription example

Testosterone Undecaneate 1,000mg every 12 weeks (every 10-20 weeks) (11,000 yen/time)

◆Ideal hormone levels

Testosterone:
Before injection 2.30-3.5ng/mL (8-12nmol/L)
1 week after injection 7.2-8.6ng/mL (25-30nmol/L)

Estradiol: Less than 19pg/mL (70pmol/L)

◆Other test items

・Blood prolactin concentration: Less than 23.5ng/mL (500mU/L)
・Liver function, kidney function, blood pressure, blood glucose, HbA1C, triglycerides, electrolytes, TSH, etc.
・Bone density: As a guideline, it should be measured regularly once you are over 50 years old
・STD tests: Perform as needed

◆Possible side effects

Androgenetic alopecia (AGA), acne, liver dysfunction, polycythemia, weight gain, high blood pressure, hyperlipidemia, liver dysfunction, mental illness, osteoporosis, sleep apnea syndrome, breast cancer, etc.

References:
#1 UK guidelines for transwomen
#2 UK guidelines for transmen
#3 Practical Guidelines for Transgender Hormone Treatment
#4 Position statement on the hormonal management of adult transgender and gender diverse individuals