TransMed

Hormones and Their Complications

by Sheila Kirk, M.D.

Medical regimens for feminization vary the world over. This is acceptable and physicians who treat the Transgendered with a contragender therapy should be knowledgeable enough to adapt their treatment plan to the needs, and even desires of their patients on an individual basis. Good medical practice with careful monitoring of the individual's overall health must accompany the hormonal reversal that takes place in the body. The sex hormones, estrogen and progesterone are used in a variety of doses, singly and combined, in commercial and natural occurring preparations and frequently in conjunction with anti-androgens. Whatever the regimen, the physician must be facile and skilled to be able to move into different regimens to accomplish the optimal clinical changes with the utmost concern for preservation of good health.

Watchfulness on the part of the physician and cooperation on the part of the patient are paramount. This is a partnership that must work together at all times.

Cardiovascular complications

The medical literature does not contain many reports of heart disease and complications in cardiac health very often in Transpeople using hormones, particularly estrogen. But the potential is there, particularly for individuals over 50 years of age and most definitely for genetic males who smoke, have altered lipid profiles, have hypertension, are overweight and have family history of coronary artery disease.

The younger population fair quite well on a hormonal regimen. Their cardiac health is generally very sound and little disease is in place when medications are initiated. None the less, controllable factors such as diet, exercise and smoking habits must be addressed and included in their health plans while using their hormones.

Older individuals need more careful pre-hormonal evaluations. Base line cardiac studies must be done and repeated at regular intervals as indicated by the individual's health status. While the medical studies were done sometime ago and the patients were elderly and not being treated as transgendered but rather for prostate malignancy, their increase in cardiac morbidity and mortality was significant enough to prompt the researchers to stop that form of treatment to control the cancer.

In current times, medications and dosages are different but very carefully formulated principles of evaluation and treatment must be adhered to by the physician and understood and embraced by the patient. It should be clearly understood that some Transgendered patients can develop heart disease on a hormonal regimen.

Hypertension or elevation in blood pressure

This is another complicating condition to be considered and managed very closely. An elevation in blood pressure already in place need not be a contraindication to an estrogen regimen provided proper pre-hormone evaluation is conducted and an appropriate treatment plan is in place.

Hormones can be started -if the blood pressure is controlled as it was in the pre-hormonal period. The hormonal regimen can continue with proper monitoring. If the hypertension is aggravated and goes higher the patient's hormone plan must be re-evaluated and redefined. If a potential for blood pressure elevation comes to light after initiating the hormone regimen-the hormone regimen must be interrupted and the patient must be evaluated carefully and completely before instituting it again. This is not to say that hypertensive individuals cannot use a feminizing hormonal regimen-they can-but the blood pressure problem must be defined and treated. Both medical regimens, for blood pressure elevation and feminizing therapy, can be compatible but all factors must be considered and acceptable to maintaining good health.

Why is hypertension such an important concern? Because in time blood pressure elevation leads to heart disease and stroke. All efforts must be taken to control such a condition to preserve life and to insure it's quality.

Phlebitis

This is not a common complication but it is a very serious one.

Once in place depending upon the degree of involvement, the individual is threatened with death because of blood clots to the lungs. Phlebitis is an inflammation of the walls of our veins and can involve the superficial or deep system of veins or both, usually in the legs and lower abdomen. A number of factors can be responsible. Suffice it to say that it will mean that the feminization process will be halted immediately and in some physician's view may never be started again.

There is a study now in progress at the Free University Hospital of Amsterdam that has a number of transgender patients who developed phlebitis on estrogen and now use a Transdermal system-a skin patch of estrogen that promotes passage of the hormone through the skin. In their study of these patients no one has had recurrent phlebitis and all are progressing well with the Estroderm patch. Physical changes and laboratory determinations are acceptable to patient and researcher. The study suggests strongly that all patients with this complication could be continued in their feminization treatment plan with this mode of therapy along with an anti-androgen. They suggest also that all transgendered patients over 40 years of age should use the patch even those never before having phlebitis. This study needs more time and more patients to observe but it is promising and places patients experiencing this very dangerous complication, who formerly were without a hope of going forward in this mode of therapy, back into a positive and progressive position.

There are other potential complications to a feminization program due principally to the estrogen in it. In my next column, other medical concerns will be discussed. Should you or your physician require additional information on the feminization process, feel free to contact me through the following means:

    e-mail: SheilaKirk@aol.com
    Phone: (412) 781-1092 Fax: (412) 781-1096
    mailing address: Sheila Kirk, P.O. Box 38114, Blawnox, Pa 15238-8114