Estrogen Therapy in Gender Dysphoria


Question

I am an endocrinologist in private practice. I have a transgender pt (male to female) who received hormone therapy in Florida, as per the pt. Could you advise me in regards to the dose of E2 the pt is maintained on and what we specifically need to monitor. I understand the mammo should be done but is there anything I need to follow? I would very much appreciate your information. Thank you. Elise Kwon, M.D.

Response

I have done this for approximately 40-50 individuals. Before starting estrogen treatment, I get a Leiden V and a prothrombin G20210A gene screen. I will usually use a 0.1 mg estradiol transdermal patch which should give a 100-150 pg/mL estradiol level. This will be easy to measure if you want and will detect any cheating or overdosing by the patient. (This group often thinks that more estrogen is better). I also get a psychology consult with a clinician experienced in gender dysphoria evaluation before starting on estrogen therapy. James H. Liu, M.D. .