Table 6.2. Major hormones involved in gender-affirming hormone therapy and their desired and adverse effects.

HORMONE	ROUTE OF ADMNISTRATION	DOSE	DESIRED EFFECTS	GENERAL ADVERSE EFFECTS
Transgender women
Estradiol valerate	Oral	2-6 mg/day	Hormone for the changes: suppresses gonadotrophins and, thus, androgen production. These changes can be definitive and should be clarified regarding fertility	Therapy with estrogens in general: • Changes in liver metabolism • Changes in cholesterol are conflicting • Increase in triglycerides • Reduction in serum homocysteine • Prothrombotic state depending on dose and administration route • Higher incidence of MI vs. cis-women • Higher incidence of stroke vs. cis-men • Higher incidence of VTE vs. cis-women and cis-men
Estradiol	Transdermal	0.025-0.2 mg/day
Estradiol (valerate or cypionate)	Parenteral	2-10 mg intramuscular/week
Anti-androgens
Spironolactone	Oral	100-300 mg/day		Anti-mineralocorticoid effect, can change blood pressure levels At high doses: potential increase in meningioma; depression and hyperprolactenemia
Cyproterone acetate	Oral	25 mg/day
Triptorelin	Subcutaneous	3.75 mg/month
Finasteride	Oral
Transgender men
Testosterone cypionate or enanthate	Parental	100-200 mg/every 4 weeks		Therapy with testosterone in general: • Adverse changes in cholesterol metabolism: increase in LDL, reduction in HDL, mild increase in triglycerides • Increased insulin resistance Increase in serum homocysteine • Increase in medio-intimal thickness with continuing use • Despite the reported adverse effects, it does not seem to increase CV outcomes in tras-men in most series. However, some studies have shown an increase in MI in trans-men vs. cis-gender in general
Testosterone decanoate	Parental	1000 mg/every 12 weeks
Testosterone gel 1.6%	Transdermal	50-100 mg/day
Testosterone patch	Transdermal	2.5-7.5 mg/day

CV: cardiovascular; MI: myocardial infarction; VTE: venous thromboembolism.