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Your appointment will then be made to getyour lab work done a week before your doctor visit and then a consultation time will also be assignedto you. Providers trained in transgender hormone therapy. Permanent changes: Some changes are reversible if you stop therapy, but voice changes and an enlarged clitoris arent. 2015 Oct126(4):859-76. doi: 10.1097/AOG.0000000000001058. Physical: Your body will change over time. Consent: We will review the benefits, risks and expected changes of hormone therapy before we write the prescriptions. Testosterone will gradually stop menstruation. Oestrogen and progestogen - 21 more in observational studies. We will not do any exams that require you to undress unless we identify an urgent need. Climacteric. The information on this page is written and peer reviewed by qualified clinicians. Expertise in coordinating your hormone therapy with your overall health. You will also meet with thepharmacistwho will review the medications commonly used. It may be the optimal progestogen in terms of cardiovascular effects, blood pressure, VTE, probably stroke and even breast cancer although this evidence is only from observational studies and they may carry a higher risk of endometrial hyperplasia[10]. This covers your initial lab workand the actual consultation with the doctor. Your provider may decide at this visit that all the information to begin therapy is in hand. You will be seen every 3 months until you are on a stable dose of the medication, at which time you will be seen every 6 months for two visits and then every year. Menopause based on symptoms, in women without a uterus. Voice therapy, vocal surgery and facial feminization surgeries are options. Langer RD; The evidence base for HRT: what can we believe? The doctor will review your personal and family health history and perform an exam. Copyright 2022 The University of Iowa. The dose, regimen and duration of HRT need to be considered for each individual. Mental health therapy: You do not need a mental health letter of support to begin hormone treatment. Never adjust your dose without consulting your LongevityMed practitioner first. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. Systemic HRT should not be arbitrarily stopped at age 65 years; treatment duration should be individualised based on a woman's risk profile and personal preference[9]. For women with a uterus, oestrogen HRT and an intrauterine system (IUS) may be an optimal combination. Smoking can cause complications. 2010 Nov26(11):804-14. doi: 10.3109/09513590.2010.495437. Take the first step to become a better you. Smoking can cause complications. As mentioned, it takes some time to get your levels back up. Those women with a history of migraines (the bolus effects of oral medication can trigger migraines in some women). Other tests, such as TFTs, glucose, cholesterol and pelvic scan, may be considered in some women. Use the lowest effective dose of HRT for the minimum duration to control symptoms. All rights reserved. They specialize in performing annual exams focusing on keeping you healthy including screening for sexually transmitted infections, screening for cancer, and making sure that you are up-to-date on vaccinations. If you recently had blood work done, please bring these results with you for the doctor to review. Breakthrough bleeding is common in the first 3-6 months of continuous combined and long-cycle HRT regimens. Some excess risk persisted for more than 10 years after stopping HRT (with longer duration of HRT associated with longer duration of persistent risk). Your hormone levelsare going to fluctuate naturally and you may need your dosages tweaked at times to adapt. LongevityMed has been great for treating me as a whole person. CHD - for women who have started combined therapy more than 10 years after menopause. Arch Gynecol Obstet. Pay your initial fee upfront. There is evidence that HRT reduces the risk of CHD, especially in women aged under 65 years. There may be long-term health risks. However, it is not a treatment for clinical anxiety or depression. It will get better from there. Some men and womenfeel better with lower numbers and others need a higher level to get the results they hope to achieve. FSH test should be undertaken in women aged under 40 years in whom menopause is suspected. Endocr Pract. If you have issueswith your menstrual cycle, be open to discuss it. At OHSU, providers will tailor your therapy to your goals. Find information on getting hormone treatment through your own primary care provider or a provider closer to your home. Patient does not provide medical advice, diagnosis or treatment. Dr. Nislyis a general Internal Medicine doctor andDr. Imborekis a Family Medicine doctor. Hormone therapy is likely to affect your sexual function and fertility, perhaps permanently. There may be a small increased risk of stroke, and endometrial and breast cancer (including breast cancer recurrence) with tibolone. You can achieve your goals with small doses. In 2003, the Million Women Study[2]found a significant increase in the risk of breast cancer for women using combined oestrogen-progestogen HRT, with little variation between specific oestrogens and progestogens or their doses, or between continuous and sequential regimens. You have decided to take the plunge and see the doctor because you are not feeling the way youwant to feel, have weight that wont come off, or depression and fatigue have taken over your everyday life. The worrying publicity that accompanied previous studies, including the Women's Health Initiative (WHI) and the Million Women Study (MWS), and the results a 2019 systematic search published in the Lancet has led to many women being concerned and anxious about the potential risks of hormone replacement therapy (HRT)[1, 2, 3]. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. Libido may be a big concern for you, but if you dont let the doctor know, it can affect what your doseis for medications prescribed. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. You may need more tests if results arent available from previous providers. You may have a preference based on your lifestyle, but the doctor may also need to work with you on what route to take, depending on which will work best for your problems. Type and timing of HRT and breast cancer risk; The Lancet, August 2019. HRT should be continued only as long as the benefit in alleviating menopause symptoms outweighs the risks associated with HRT use. A recommended health care routine and screenings. 2014 May 2220(2):69-72. OHSUs Transgender Gynecology clinic and many OHSU primary care clinicsoffer: This page is about hormone therapy for adults, who can be treated by a primary care provider. Micronised progesterone is a natural, 'body-identical' progestogen, devoid of any androgenic as well as glucocorticoid activities but being slightly hypotensive due to anti-mineralocorticoid activity. Oestrogen: breast tenderness, leg cramps, bloating, nausea, headaches. Hormone replacement therapy (HRT): further information on the known increased risk of breast cancer with HRT and its persistence after stopping; Medicines and Healthcare products Regulatory Agency, August 2019. Maturitas. To get the process started and start living your life to the fullest, please fill out the form below and someone will be in touch with you shortly. Your consultation with a LongevityMed Practitioneris your time to tell them everything that is going on with you. You may find out that you are doing better than you think and the cost is not as expensive as anticipated. Serious health risks are uncommon, but your doctor may monitor you for: Temporary hot flashes, mood swings and headaches, Thicker, more oily skin that may cause acne, Less fat in thighs and hips, and possibly more in your belly, Thicker, darker, faster-growing hair on your chest, arms, legs and back, More facial hair, although beard development varies widely. OHSU offers hormone therapy in welcoming environments at: Our providers are trained to assess how to safely and optimally begin your hormone therapy. Supplements can be bought at any store or pharmacy that carries them, or online. Early menopause relates to those women aged <45 years. This brings up the plan. After you find out your hormone needs, you will decide what plan to goon. Most patients receive consultations every three or four months, getting lab work donea week prior to each appointment. The evaluation should focus on your gender history and ability to understand the risks and benefits of treatment used to transition to another gender. 2015 May81(1):69-75. doi: 10.1016/j.maturitas.2015.02.263. See the paragraph at the bottom of the separate Menopause and its Management article. The doses of your medicine(s) may be adjusted at this visit. However, the increased occurrence of these events (VTE, pulmonary embolism and stroke) can be prevented by the use of the transdermal route of estradiol administration. Reduction of osteoporosis and also reduction in osteoporosis-related fractures. If you have other medical conditions, you may need to be seen more often. Fertility may or may not return for patients who still have ovaries. Well also check for signs of potential effects such as changes in your blood counts or cholesterol: Regular doses of the hormone estrogen, also called estradiol, develop feminine traits and reduce masculine ones. 2003 Aug 9362(9382):419-27. Patient is a UK registered trade mark. The payment plans are waysto divide up payments that cover all the appointments, medications, and lab work. Any mental health therapy youve had or plan to have, and help finding a therapist if needed. Make sure your health care provider knows your health history, any medications youre taking and whether you smoke. We will ask you to sign a consent form to document your understanding of this information. It will give you a better understanding of interpreting how your body works. You may experience: Regular doses of the hormone testosterone increase masculine traits and reduce feminine ones. OHSU is an equal opportunity affirmative action institution. You do not need a mental health letter of support to begin hormone treatment. Vasomotor symptoms (including sleep or mood disturbance caused by these symptoms). It can be used in women with an intact uterus who have had no bleeding for more than one year, without the need for cyclical progestogen. This usually happens a few weeks after your first visit. It causes physical, emotional and other changes so you more closely match your gender identity. Here is an explanation of what you can expect. Someday it will be widely accepted thatprevention is less costly than treating sickness. You will have baseline blood work done during this visit. Your hormone levels will not be exactly like anyone elses. They are written by UK doctors and based on research evidence, UK and European Guidelines. The following procedures are offered at the UI Hospitals & Clinics for transwomen (male to female persons): The following procedures are offered at the UI Hospitals & Clinics for transmen (female to male persons): It is the policy of the UI Hospitals & Clinics that patients are seen first in the UI LGBTQ Clinic before being referred to one of the surgical specialists for transgender surgical care. She will review the risks of the medications and common side effects as well as a timeline of expected changes.