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GIC Guidelines for GP’s prescribing hormones, monitoring blood & side effects,

Reference: 25-26434

Date response sent: 30/06/2025

Details of enquiry

Please advise what national or international guideline were used by the Tavistock and Portman GIC to produce prescribing guidelines for GPs e.g. shared care agreements, directed/ local enhanced services or prescribing guidelines. Please consider advice given to GPs on prescribing oestrogen or testosterone, blood monitoring and monitoring for adverse effects

Response sent

Please advise what national or international guideline were used by the Tavistock and Portman GIC to produce prescribing guidelines for GPs e.g. shared care agreements, directed/ local enhanced services or prescribing guidelines. Please consider advice given to GPs on prescribing oestrogen or testosterone, blood monitoring and monitoring for adverse effects

The GIC’s prescribing guidelines are based on a general overview of academic papers on gender care and prescribing, as well as international guidelines published in respected peer-reviewed journals, as listed below.

The GIC’s prescribing advice including guidelines for GPs do not follow a particular national or international set of guidelines but follow a mixture of best practice guidelines contained within the academic papers listed.

Please note that whilst these academic references are all listed below for your perusal, you may find that some of them sit behind a pay wall, and the Trust has no control over this.

Listing of National and International Guidelines on Gender Care and Prescribing.

 

  1. NHS-England-Service-Specification-for-Specialised-Gender-Dysphoria-Services-Surgical-v4.pdf
  2. D’hoore, L. and G. T’Sjoen, Gender-affirming hormone therapy: An updated literature review with an eye on the future. J Intern Med, 2022. 291(5): p. 574-592.
  3. Seal, L.J., Hormone treatment for transgender adults, in The transgender handbook : a guide for transgender people, their families and professionals, W.P.A. Bouman, Jon, Editor. 2017, Nova Publishers: New York. p. 227-249.
  4. Seal, L.J., A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria. Ann Clin Biochem, 2016. 53(Pt 1): p. 10-20.
  5. Nota, N.M., et al., The Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy: Results from a Large Cohort Study. Circulation, 2019.
  6. van Kesteren, P., et al., Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones. Clin Endocrinol (Oxf), 1998. 48(3): p. 347-54.
  7. Totaro, M., et al., Risk of Venous Thromboembolism in Transgender People Undergoing Hormone Feminizing Therapy: A Prevalence Meta-Analysis and Meta-Regression Study. Front Endocrinol (Lausanne), 2021. 12: p. 741866.
  8. Toorians, A.W., et al., Venous thrombosis and changes of hemostatic variables during cross-sex hormone treatment in transsexual people. J Clin Endocrinol Metab, 2003. 88(12): p. 5723-9.
  9. Seal, L.J., et al., Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens. J Clin Endocrinol Metab, 2012. 97(12): p. 4422-8.
  10. Beral, V., E. Banks, and G. Reeves, Evidence from randomised trials on the long-term effects of hormone replacement therapy. Lancet, 2002. 360(9337): p. 942-4.
  11. Hulley, S., et al., Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA, 1998. 280(7): p. 605-13.
  12. Rossouw, J.E., et al., Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA, 2002. 288(3): p. 321-33.
  13. de Blok, C.J.M., et al., Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ, 2019. 365: p. l1652.
  14. Futterweit, W., Endocrine therapy of transsexualism and potential complications of long-term treatment. Arch Sex Behav, 1998. 27(2): p. 209-26.
  15. Nota, N.M., et al., The occurrence of benign brain tumours in transgender individuals during cross-sex hormone treatment. Brain, 2018. 141(7): p. 2047-2054.
  16. van Kesteren, P.J., et al., Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol (Oxf), 1997. 47(3): p. 337-42.
  17. Futterweit, W., Endocrine therapy of transsexualism and potential complications of long-term treatment. Arch Sex Behav, 1998. 27(2): p. 209-26.
  18. de Nie, I., et al., Prostate Cancer Incidence under Androgen Deprivation: Nationwide Cohort Study in Trans Women Receiving Hormone Treatment. J Clin Endocrinol Metab, 2020. 105(9): p. e3293-9.
  19. Getahun, D., et al., Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Ann Intern Med, 2018. 169(4): p. 205-213.
  20. Nota, N.M., et al., Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy. Circulation, 2019. 139(11): p. 1461-1462.
  21. van Zijverden, L.M., et al., Cardiovascular disease in transgender people: a systematic review and meta-analysis. Eur J Endocrinol, 2024. 190(2): p. S13-S24.
  22. Carrasquilla, G.D., et al., Postmenopausal hormone therapy and risk of stroke: A pooled analysis of data from population-based cohort studies. PLoS Med, 2017. 14(11): p. e1002445.
  23. Vinogradova, Y., C. Coupland, and J. Hippisley-Cox, Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ, 2019. 364: p. k4810.
  24. Asscheman, H., et al., A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol, 2011. 164(4): p. 635-42.
  25. Dhejne, C., et al., Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One, 2011. 6(2): p. e16885.
  26. Seal, L., J., Hormone Treatment of Adults, in The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, W.P. Bouman and J. Arcelus, Editors. 2017, Nova Science Publishers: New York.
  27. Hembree, W.C., et al. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903
  28. NICE (2024) Guidelines on diagnosis and assessment of prostate cancer (September 2024 revision): http://https//cks.nice.org.uk/topics/prostate-cancer/diagnosis/assessment/#psa-testing
  29. Gilsanz, P., et al. (2015). The Effects of Estrogen on the Kidney and Fluid Balance: Insights from Clinical Studies. Hypertension, 65(4), 823-829.
  30. Dinesh, S. R., & Brown, R. W. (2018). Effect of Estrogen on Kidney Function and Disease. Journal of Clinical Endocrinology & Metabolism, 103(8), 3456-3463.
  31. Coleman, E., et al., Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health, 2022. 23(Suppl 1): p. S1-S259
  32. Wylie, K., Barrett, J., Besser, M., Bouman, W., Brain, C., Bridgman, M.,…Ward, D. (2013). Good practice guidelines for the assessment and treatment of adults with gender dysphoria (R C Psych College Reports, Issue. R. C. o. Psychiatrists.
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