Appendix 2 Guidelines for hormone therapy for gender dysphoria in trans women and post-genital operation or gender recognition certificated women

摘要

It has been traditional to use the androgen receptor-blocking drug cyproterone acetate or the potassium-retaining diuretic spironoiactone, which has similar effects, to suppress the effects of circulating androgens such as testosterone, dihydrotestosterone, androstenedione and dehydro-epiandrosterone (DHEA). There may be problems, however, with the use of cyproterone acetate, which is, at least in part, dose dependent. High doses of cyproterone acetate are associated with glucocorticoid effects, although this is more apparent in children and adolescents than adults. Hepatotoxicity is recognised in animal models on long-term therapy and indeed hepatic tumours occur in rats. Although this has not clearly been seen in humans, hepatic dysfunction does occur rarely. The Medicines and Healthcare products Regulatory Agency has issued a warning of potential risk of (multiple) meningiomas (Medicines and Healthcare products Regulatory Agency, 2009). Cyproterone can also cause depression. Spironoiactone causes elevated potassium and low sodium levels in the blood. There are alternative and preferable ways of suppressing secretion of endogenous androgens and their effects.