Clinical Scorecard: Erratum: Discussion on the Use of Injectable Estradiol in Transgender and Gender-diverse Populations in the U.S.
At a Glance
Category
Detail
Condition
Hormone therapy in transgender and gender-diverse populations
Key Mechanisms
Use of injectable estradiol to achieve testosterone suppression and maintain estradiol concentrations within guideline-recommended ranges
Target Population
Transgender and gender-diverse individuals with intact gonads receiving injectable estradiol
Care Setting
Endocrinology and gender-affirming hormone therapy clinical settings
Key Highlights
Only 21.6% of patients injecting estradiol every 7 days achieved both testosterone suppression (<50 ng/dL) and guideline-recommended estradiol levels (100-200 pg/mL) without antiandrogens or GnRHa.
It is unclear how the majority of patients (78.4%) achieved testosterone suppression without concurrent antiandrogen therapy.
Further research is needed to clarify the efficacy of estradiol monotherapy in achieving both testosterone suppression and appropriate estradiol concentrations.
Guideline-Based Recommendations
Diagnosis
Management
Monitor serum estradiol concentrations aiming for 100-200 pg/mL as per guidelines.
Consider concurrent use of antiandrogens or GnRHa to achieve testosterone suppression below 50 ng/dL when using injectable estradiol.
Monitoring & Follow-up
Regularly assess serum testosterone and estradiol levels to evaluate hormone therapy effectiveness.
Monitor for potential risks associated with supraphysiologic estradiol concentrations, including thromboembolic disease, liver dysfunction, and hypertension.
Risks
Risks may increase with estradiol concentrations above the physiologic range, including thromboembolic events, liver dysfunction, and hypertension.
Patient & Prescribing Data
Patients with intact gonads receiving injectable estradiol every 7 days
Only a minority (21.6%) achieved both testosterone suppression and guideline-recommended estradiol levels without antiandrogens, indicating possible need for adjunctive therapies.
Clinical Best Practices
Use combined hormone therapy (estradiol plus antiandrogens or GnRHa) to reliably achieve testosterone suppression.
Individualize hormone therapy monitoring to balance efficacy and minimize risks.
Further clinical investigation is necessary to optimize estradiol monotherapy protocols.
