Terapia ormonale di affermazione di genere nelle persone transgender e gender diverse

Gender affirming hormonal treatment (GAHT) may be required by some transgender (trans) and gender diverse (GD) people, in order to achieve body changes consistent with their gender identity. In assigned female at birth (AFAB) people, the virilising and de-feminising treatment typically consists of testosterone (T), with the aim of inducing body modifications such as amenorrhoea, an increase in face and body hair distribution, in muscular mass, clitoral enlargement, as well as lowering of the voice. The onset or increase of acne, male pattern alopecia, polycythaemia, and unfavourable changes in lipid asset are the most common side effects of T therapy, making a thorough clinical-biochemical monitoring necessary. In some cases, trans/GD people may desire a partial virilisation and/or de-feminisation, thus a GAHT with lower dosages of T, together with non-hormonal treatment strategies, could be offered, taking into consideration the possible risks of such interventions. Feminising and de-virilising therapy in assigned male at birth individuals (AMAB) is based on oestrogens (in several formulations) and antiandrogens, in particular cyproterone acetate (CPA), gonadotropin releasing hormone agonists (GnRHa) or spironolactone as a second choice. Breast development, reduction in face and body hair distribution, in skin oiliness, in testicular volume and in spontaneous erections, as well as a body fat redistribution in gynoid regions are expected body changes under oestrogens and antiandrogens. Oestrogen therapy may be associated with an increased risk of venous thrombo-embolism, while antiandrogen therapies are associated with specific – although uncommon – side-effects; thus, a cautious clinical and biochemical monitoring is recommended. For some AMAB trans/GD persons, the desired body changes might consist of a partial feminisation and/or devirilisation; thus, a therapy with lower dosages of oestrogens and/or antiandrogens might be offered, taking in consideration the person’s embodiment goals, and carefully balancing the risks and benefits of this treatment, especially its possible impact on the bone and cardiovascular health of the client.