Open AccessRelationship Between Serum Estradiol Concentrations and Clinical Outcomes in Transgender Individuals Undergoing Feminizing Hormone Therapy: A Narrative Review
Author(s) -
Brendan J Nolan,
Ada S Cheung
Publication year - 2021
Publication title -
transgender health
Language(s) - English
Resource type - Journals
eISSN - 2688-4887
pISSN - 2380-193X
DOI - 10.1089/trgh.2020.0077
Subject(s) - feminization (sociology) , transgender , testosterone (patch) , estrogen , sex hormone binding globulin , transgender women , medicine , hormone therapy , endocrinology , hormone , physiology , bone mineral , androgen , psychology , osteoporosis , breast cancer , human immunodeficiency virus (hiv) , cancer , immunology , gender studies , syphilis , men who have sex with men , sociology , psychoanalysis
Transgender, including gender diverse and nonbinary, individuals are treated with estradiol with or without antiandrogen to align their physical appearance with their gender identity, improve mental health and quality of life. Consensus guidelines give target ranges for serum estradiol concentration based on premenopausal female reference ranges. However, limited studies have evaluated the relationship between serum estradiol concentrations and clinical outcomes in transgender individuals undergoing feminizing hormone therapy. The available evidence has not found that higher serum estradiol concentrations, together with suppressed testosterone, enhance breast development, or produce more feminine changes to body composition. However, ensuring testosterone suppression appears to be an important factor to maximize these physical changes. Higher serum estradiol concentrations have been associated with higher areal bone mineral density. Although the resultant long-term clinical implications are yet to be determined, this could be a consideration for individuals with low bone mass. The precise serum estradiol concentration that results in adequate feminization without increasing the risk of complications (thromboembolic disease, cholelithiasis) remains unknown. Further prospective trials are required.