Dr. Susanne Junginger & Dr. Achim Wüsthof (Germany)
Endocrinological care of transgender (adolescents and adults) according to German guidelines
After the careful psychological evaluation of an adolescent with gender dysphoria, a puberty suppression with GnRH-analogues can be initiated, if Tanner stage 2 has been reached. Trans boys/men with an advanced puberal development, who are already menstruating, can receive gestates to suppress menstruation instead of the GnRH analogues. Trans girls/women may alternatively benefit from a cyproterone acetate, bicalutamide or spironolactone administration to reduce testosterone effects.
In the case of trans boys/men, we usually initiate the gender affirming hormonal treatment with a transdermal testosterone. For growing adolescents, the dosage should be reduced with the aim of improving their final height. In further treatment, when growth has been completed, testosterone undecanoate can be administered as an injection every three months.
In trans girls/women we start the feminizing treatment with estradiol (valerate). If the still growing trans girl/woman has a tall genetic target height, we use ethinylestradiol (100 ug/day) to promote an earlier closure of the epiphysis to reduce the final height. In adult transwomen, transdermal estradiol is preferred, especially if there is a risk factor. Transdermal estradiol is the treatment of choice for all trans women older than 40 years.
Bio
Dr. Susanne Junginger is an internal endocrinologist and diabetologist. She studied in Cologne and Santiago de Chile and worked at the University Medical Centre Frankfurt from 2004 to 2010 and at the Endokrinologikum Hannover and Hamburg since 2010. She cares for adults with hormonal disorders, particularly transgender persons, whom she provides endocrinological support. She is a member of the German Society for Adult Endocrinology and Diabetology (DGE). She participated in the AWMF-S2k guideline “Gender Incongruence and Gender Dysphoria in Children and Adolescents – Diagnosis and Treatment” and participates actually in the AWMF S2k guideline “Hormonal Therapy in Adult Gender Incongruence Persons”.
Dr. Achim Wüsthof, born in 1967, is a paediatric endocrinologist and diabetologist. He worked at the University Medical Centre Hamburg-Eppendorf from 1994 to 2005 and at the Endokrinologikum in Hamburg since 2005. He cares for children and adolescents with hormonal disorders, particularly transgender adolescents, whom he provides endocrinological support. He is a member of the German Society for Paediatric and Adolescent Endocrinology and Diabetology (DGPAED). He participated in the steering group for the development of the AWMF-S2k guideline “Gender Incongruence and Gender Dysphoria in Children and Adolescents – Diagnosis and Treatment” and co-authored the chapter “Somatic Aspects of Hormonal Interventions” with Annette Richter-Unruh.