Therapy with Anti-androgens in Gender Dysphoric Natal Males

In adult gender dysphoric natal males, where full development of male secondary sexual characteristics has already taken place, the goal of cross-sex hormonal therapy is the suppression of testosterone secretion to achieve regression of male characteristics and the development of feminine secondary sexual characteristics. For this reason, in transwomen an almost complete suppression of endogenous androgen production and action with combined administration of estrogens is required. The aim of therapy is to maintain hormone levels within the normal physiological range for the individual’s desired gender. Practice guidelines describe eligibility for puberty suppression in adolescents that have met the criteria for gender dysphoria and that have experienced at least Tanner stage 2 puberty. In these subjects if dysphoria persists, cross-hormonal therapy is generally started after 16 years of age.