女性化激素疗法:修订间差异
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'''女性化激素疗法'''({{lang-en|'''Feminizing hormone therapy'''}})是一种[[激素替代療法|激素替代疗法]](HRT),通过进行这种治疗可以将[[跨性別者|跨性别者]]的[[第二性征]]从男或中性特征变成女性特征。<ref name="pmid28945902B">{{cite journal|title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline|url=https://academic.oup.com/jcem/article-pdf/102/11/3869/21533864/jc.2017-01658.pdf|date=November 2017|journal=J. Clin. Endocrinol. Metab.|issue=11|doi=10.1210/jc.2017-01658|volume=102|pages=3869–3903|pmid=28945902|vauthors=Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG|s2cid=3726467}}</ref><ref name="ColemanBockting2012B">{{cite journal|title=Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7|url=https://www.wpath.org/media/cms/Documents/Web%20Transfer/SOC/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf|first1=E.|last2=Bockting|first2=W.|journal=[[International Journal of Transgenderism]]|issue=4|doi=10.1080/15532739.2011.700873|year=2012|volume=13|pages=165–232|issn=1553-2739|last3=Botzer|first3=M.|last4=Cohen-Kettenis|first4=P.|last5=DeCuypere|first5=G.|last6=Feldman|first6=J.|last7=Fraser|first7=L.|last8=Green|first8=J.|last9=Knudson|first9=G.|first26=B.|last30=Vitale|last27=Schechter|first27=L. S.|last28=Tangpricha|first28=V.|last26=Robinson|last29=van Trotsenburg|first29=M.|first34=K.|first30=A.|last31=Winter|first31=S.|last32=Whittle|first32=S.|last33=Wylie|first33=K. R.|last34=Zucker|last25=Rachlin|s2cid=39664779|first25=K.|last1=Coleman|first24=F.|last16=Ettner|last10=Meyer|first10=W. J.|last11=Monstrey|first11=S.|last12=Adler|first12=R. K.|last13=Brown|first13=G. R.|last14=Devor|first14=A. H.|last15=Ehrbar|first15=R.|first16=R.|last24=Pfaefflin|last17=Eyler|first17=E.|last18=Garofalo|first18=R.|last19=Karasic|first19=D. H.|last20=Lev|last21=Mayer|first21=G.|last22=Meyer-Bahlburg|first22=H.|last23=Hall|first23=B. P.|first20=A. I.}}</ref><ref name="Deutsch20162">{{cite web|title=Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People|url=http://transhealth.ucsf.edu/pdf/Transgender-PGACG-6-17-16.pdf|date=17 June 2016|last=Deutsch|first=Madeline|publisher=Center of Excellence for Transgender Health|edition=2nd|location=University of California, San Francisco|page=28}}</ref><ref name="pmid28159148y">{{cite journal|title=Hormonal and Surgical Treatment Options for Transgender Women and Transfeminine Spectrum Persons|date=March 2017|journal=Psychiatr. Clin. North Am.|issue=1|doi=10.1016/j.psc.2016.10.006|volume=40|pages=99–111|pmid=28159148|vauthors=Wesp LM, Deutsch MB}}</ref><ref name="DahlFeldman20152">{{cite web|title=Endocrine Therapy for Transgender Adults in British Columbia: Suggested Guidelines|url=http://www.phsa.ca/transcarebc/Documents/HealthProf/BC-Trans-Adult-Endocrine-Guidelines-2015.pdf|access-date=15 August 2018|date=2015|publisher=[[Vancouver Coastal Health]]|last1=Dahl|first1=M|last2=Feldman|first2=JL|last3=Goldberg|first3=J|last4=Jaberi|first4=A}}</ref>这是两种对跨性别者的治疗之一(另一种是[[男性化激素疗法]])。一些人,特别是[[雙性人|双性人]],但也有一些双性恋者也采取这种形式的治疗,根据他们的个人需要和偏好。有的人为了巩固指定的性别特征从幼年开始进行此疗法,有的晚些开始。 |
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[[跨性別女性|从男性到女性]](MTF)的[[激素替代疗法]](HRT)是一种激素疗法和变性治疗的方式,通过进行这种治疗可以将[[跨性别者]]和易性者的[[第二性征]]从男或中性特征变成女性特征。这是两种对跨性别者和易性者的治疗之一,另一种是主要用于意欲变性的女性的[[跨性別男性|从男性到女性]]的激素替代疗法(FTM)。一些双性人也接受MTF的HRT,有的为了巩固指定的性别特征所以从幼年开始,有的晚些开始,如果之前指定的性别被证明是错误的。 |
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该疗法的目的是引起患者希望成为的性别的第二性征的发育,例如发育[[乳房]],使[[毛发]]、[[脂肪]]和[[肌肉]]以女性的模式分布等。它不能消除许多[[青春期]]时导致的变化,这些不能被消除的变化需要进一步手术或其他治疗。用于女性化激素疗法的药物包括[[雌激素]]、[[抗雄激素]]、[[孕激素]]和[[促性腺素釋素|促性腺素释素]](GnRH调节剂)。 |
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女性化激素疗法已被证明可以缓解与[[性別不安|性别不安]]相关的部分或全部痛苦和不适。<ref>{{Cite journal|title=Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes|first1=Mohammad Hassan|last2=Elamin|first2=Mohamed B.|journal=Clinical Endocrinology|issue=2|doi=10.1111/j.1365-2265.2009.03625.x|year=2010|volume=72|pages=214–231|pmid=19473181|last3=Garcia|first3=Magaly Zumaeta|last4=Mullan|first4=Rebecca J.|last5=Murad|first5=Ayman|last6=Erwin|first6=Patricia J.|last7=Montori|first7=Victor M.|last1=Murad|s2cid=19590739}}</ref> |
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== 要求 == |
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{{Main|跨性别激素疗法#要求|跨性别激素疗法#Accessibility}}许多医生按照[[世界跨性别人士健康专业协会]](WPATH)的护理标准(SoC)模式运作,要求跨性别者接受心理治疗并提供心理治疗师的推荐信,以便获得激素治疗。其他医生按照[[知情同意]]模式运作,除了同意之外,对跨性别激素疗法没有要求。 |
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跨性别激素疗法的可及性在全世界和各个国家都有所不同。 |
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== 药物 == |
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各种不同的[[性激素药物]]被用于女性化激素疗法。<ref name="Deutsch20163">{{cite web|title=Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People|url=http://transhealth.ucsf.edu/pdf/Transgender-PGACG-6-17-16.pdf|date=17 June 2016|last=Deutsch|first=Madeline|publisher=Center of Excellence for Transgender Health|edition=2nd|location=University of California, San Francisco|page=28}}</ref><ref name="pmid28159148y2">{{cite journal|title=Hormonal and Surgical Treatment Options for Transgender Women and Transfeminine Spectrum Persons|date=March 2017|journal=Psychiatr. Clin. North Am.|issue=1|doi=10.1016/j.psc.2016.10.006|volume=40|pages=99–111|pmid=28159148|vauthors=Wesp LM, Deutsch MB}}</ref>这些药物包括[[雌激素]],以诱导[[女性化]]并抑制[[睾酮]]水平;[[抗雄激素]],如雄性激素拮抗剂、抗促性腺激素、GnRH调节剂和5α-还原酶抑制剂,以进一步对抗睾酮等雄激素的作用;以及[[孕激素]],以获得各种可能但不确定的益处。<ref name="Deutsch20163" /><ref name="pmid28159148y2" />雌激素与抗雄激素联合使用是女性化激素疗法的主流。<ref name="Shore2014">{{cite book|author=William B. Shore|title=Adolescent Medicine, An Issue of Primary Care: Clinics in Office Practice, E-Book|url=https://books.google.com/books?id=JnVYBAAAQBAJ&pg=PA663|date=21 August 2014|publisher=Elsevier Health Sciences|isbn=978-0-323-32340-6|pages=663–}}</ref><ref name="AlexanderJohnson-Mallard2017">{{cite book|author1=Ivy M. Alexander|author2=Versie Johnson-Mallard|author3=Elizabeth Kostas-Polston|author4=Catherine Ingram Fogel, Nancy Fugate Woods|title=Women's Health Care in Advanced Practice Nursing, Second Edition|url=https://books.google.com/books?id=8S4oDwAAQBAJ&pg=PA468|date=28 June 2017|publisher=Springer Publishing Company|isbn=978-0-8261-9004-8|pages=468–}}</ref> |
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=== 雌激素 === |
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{{See also|雌激素#跨性别女性|雌二醇#跨性别女性}}[[雌激素]]是女性体内的主要性激素,负责发展和维持女性的第二性征,如乳房、宽臀部和女性的脂肪分布模式。<ref name="pmid28159148y" />雌激素通过结合并激活雌激素受体(ER)发挥作用,ER是雌激素在体内的[[靶点 (生物学)|生物靶点]]。<ref name="pmid16112947">{{cite journal|title=Pharmacology of estrogens and progestogens: influence of different routes of administration|url=http://hormonebalance.org/images/documents/Kuhl%2005%20%20Pharm%20Estro%20Progest%20Climacteric_1313155660.pdf|journal=Climacteric|doi=10.1080/13697130500148875|year=2005|volume=8 Suppl 1|pages=3–63|pmid=16112947|vauthors=Kuhl H|s2cid=24616324}}</ref>有各种不同形式的雌激素可供选择,并在医学上使用。<ref name="pmid28159148y" /><ref name="pmid16112947" />最常见的用于跨性别女性的雌激素包括[[雌二醇]],它是女性体内最主要的天然雌激素,以及雌二醇酯,如戊酸雌二醇和环戊酸雌二醇,它们是雌二醇的[[前体药物]]。[[結合型雌激素|结合型雌激素]],用于[[激素替代療法|绝经期激素治疗]](MHT),以及炔雌醇,用于[[避孕药]],过去曾用于跨性别女性,但由于其[[血栓]]和[[心血管]]问题的风险较高,不再被推荐,现在也很少使用。<ref name="pmid28159148y" /><ref name="DahlFeldman20152" />雌激素可通过[[口服给药|口服]]、[[口腔黏膜吸收|舌下含服]]、经皮/[[外用藥物|局部]](通过贴片或凝胶)、直肠、[[肌肉注射|肌肉]]或[[皮下注射|皮下]]注射或[[植入物 (醫學)|植入]]的方式给药。首选肠外(非口服)途径,因为血凝块和心血管问题的风险最小或可忽略不计。<ref name="DahlFeldman20152" /><ref name="pmid30073551">{{cite journal|title=Cardiovascular health in transgender people|date=September 2018|journal=Rev Endocr Metab Disord|issue=3|doi=10.1007/s11154-018-9454-3|volume=19|pages=243–251|pmid=30073551|vauthors=Irwig MS|s2cid=51908458}}</ref><ref name="pmid29987313">{{cite journal|title=Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study|date=August 2018|journal=Ann. Intern. Med.|issue=4|doi=10.7326/M17-2785|volume=169|pages=205–213|pmc=6636681|pmid=29987313|vauthors=Getahun D, Nash R, Flanders WD, Baird TC, Becerra-Culqui TA, Cromwell L, Hunkeler E, Lash TL, Millman A, Quinn VP, Robinson B, Roblin D, Silverberg MJ, Safer J, Slovis J, Tangpricha V, Goodman M}}</ref><ref name="pmid17019433">{{cite journal|title=Therapy Insight: parenteral estrogen treatment for prostate cancer—a new dawn for an old therapy|date=October 2006|journal=Nat Clin Pract Oncol|issue=10|doi=10.1038/ncponc0602|volume=3|pages=552–63|pmid=17019433|vauthors=Ockrim J, Lalani EN, Abel P|s2cid=6847203}}</ref><ref name="pmid17239273">{{cite journal|title=Parenteral estrogens for prostate cancer: can a new route of administration overcome old toxicities?|date=December 2006|journal=Clin Genitourin Cancer|issue=3|doi=10.3816/CGC.2006.n.037|volume=5|pages=198–205|pmid=17239273|vauthors=Lycette JL, Bland LB, Garzotto M, Beer TM}}</ref> |
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女性化激素疗法(英語:Feminizing hormone therapy)是一种激素替代疗法(HRT),通过进行这种治疗可以将跨性别者的第二性征从男或中性特征变成女性特征。[1][2][3][4][5]这是两种对跨性别者的治疗之一(另一种是男性化激素疗法)。一些人,特别是双性人,但也有一些双性恋者也采取这种形式的治疗,根据他们的个人需要和偏好。有的人为了巩固指定的性别特征从幼年开始进行此疗法,有的晚些开始。
该疗法的目的是引起患者希望成为的性别的第二性征的发育,例如发育乳房,使毛发、脂肪和肌肉以女性的模式分布等。它不能消除许多青春期时导致的变化,这些不能被消除的变化需要进一步手术或其他治疗。用于女性化激素疗法的药物包括雌激素、抗雄激素、孕激素和促性腺素释素(GnRH调节剂)。
女性化激素疗法已被证明可以缓解与性别不安相关的部分或全部痛苦和不适。[6]
要求
许多医生按照世界跨性别人士健康专业协会(WPATH)的护理标准(SoC)模式运作,要求跨性别者接受心理治疗并提供心理治疗师的推荐信,以便获得激素治疗。其他医生按照知情同意模式运作,除了同意之外,对跨性别激素疗法没有要求。
跨性别激素疗法的可及性在全世界和各个国家都有所不同。
药物
各种不同的性激素药物被用于女性化激素疗法。[7][8]这些药物包括雌激素,以诱导女性化并抑制睾酮水平;抗雄激素,如雄性激素拮抗剂、抗促性腺激素、GnRH调节剂和5α-还原酶抑制剂,以进一步对抗睾酮等雄激素的作用;以及孕激素,以获得各种可能但不确定的益处。[7][8]雌激素与抗雄激素联合使用是女性化激素疗法的主流。[9][10]
药品 | 商品名 | 类型 | 途径 | 剂量[b] |
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雌二醇 | 多种 | 雌激素 | 口服 | 2–10毫克/日 |
多种 | 雌激素 | 舌下 | 1–8毫克/日 | |
康美华(Climara)[c] | 雌激素 | 透皮贴片 | 25–400微克/日 | |
迪维舒凝胶(Divigel)[c] | 雌激素 | 透皮凝胶 | 0.5–5毫克/日 | |
多种 | 雌激素 | 皮下植入 | 50–200毫克每6–24个月 | |
戊酸雌二醇 | 补佳乐(Progynova) | 雌激素 | 口服 | 2–10毫克/日 |
补佳乐(Progynova) | 雌激素 | 舌下 | 1–8毫克/日 | |
Del雌激素(Delestrogen)[c] | 雌激素 | 肌肉注射,皮下注射 | 2–10毫克/周或 5–20毫克每2周 | |
环戊丙酸雌二醇 | 狄波-雌二醇(Depo-Estradiol) | 雌激素 | 肌肉注射,皮下注射 | 2–10毫克/周或 5–20毫克每2周 |
苯甲酸雌二醇 | 保女荣-B(Progynon-B) | 雌激素 | 肌肉注射,皮下注射 | 0.5–1.5毫克每2–3日 |
雌三醇 | 欧维婷(Ovestin)[c] | 雌激素 | 口服 | 4–6毫克/日 |
螺内酯 | 安体舒通(Aldactone) | 抗雄激素 | 口服 | 100–400毫克/日 |
醋酸环丙孕酮 | 色普龙(Androcur) | 抗雄激素; 孕激素 |
口服 | 5–100毫克/日 |
色普龙长效(Androcur Depot) | 肌肉注射 | 300毫克/月 | ||
比卡鲁胺 | 康士得(Casodex) | 抗雄激素 | 口服 | 25–50毫克/日 |
恩扎卢胺 | 安可坦(Xtandi) | 抗雄激素 | 口服 | 160毫克/日 |
促性腺激素释放激素类似物 | 多种 | 促性腺激素释放激素调节剂 | 多种 | 多变 |
噁拉戈利 | Orilissa | 促性腺激素释放激素拮抗剂 | 口服 | 150毫克/日或 200毫克每日两次 |
非那斯特莱 | 保法止(Propecia) | 5α-还原酶抑制剂 | 口服 | 1–5毫克/日 |
度他雄胺 | 安福达(Avodart) | 5α-还原酶抑制剂 | 口服 | 0.25–0.5毫克/日 |
孕酮 | Prometrium[c] | 孕激素 | 口服 | 100–400毫克/日 |
醋酸甲羟孕酮 | 普维拉(Provera) | 孕激素 | 口服 | 2.5–40毫克/日 |
狄波-普维拉(Depo-Provera) | 孕激素 | 肌肉注射 | 150毫克每3个月 | |
狄波-皮下普维拉104(Depo-SubQ Provera 104) | 孕激素 | 皮下注射 | 104毫克每3个月 | |
己酸羟孕酮 | 普罗路通(Proluton) | 孕激素 | 肌肉注射 | 250毫克/周 |
地屈孕酮 | 达芙通(Duphaston) | 孕激素 | 口服 | 20毫克/日 |
屈螺酮 | Slynd | 孕激素 | 口服 | 3毫克/日 |
多潘立酮[d] | 吗丁啉(Motilium) | 催乳素释放剂 | 口服 | 30–80毫克/日[e] |
雌激素
雌激素是女性体内的主要性激素,负责发展和维持女性的第二性征,如乳房、宽臀部和女性的脂肪分布模式。[4]雌激素通过结合并激活雌激素受体(ER)发挥作用,ER是雌激素在体内的生物靶点。[47]有各种不同形式的雌激素可供选择,并在医学上使用。[4][47]最常见的用于跨性别女性的雌激素包括雌二醇,它是女性体内最主要的天然雌激素,以及雌二醇酯,如戊酸雌二醇和环戊酸雌二醇,它们是雌二醇的前体药物。结合型雌激素,用于绝经期激素治疗(MHT),以及炔雌醇,用于避孕药,过去曾用于跨性别女性,但由于其血栓和心血管问题的风险较高,不再被推荐,现在也很少使用。[4][5]雌激素可通过口服、舌下含服、经皮/局部(通过贴片或凝胶)、直肠、肌肉或皮下注射或植入的方式给药。首选肠外(非口服)途径,因为血凝块和心血管问题的风险最小或可忽略不计。[5][48][49][50][51]
效果 | 效果发生的预期时间[a] | 效果最大化的预期时间[a][b] | 激素治疗停止后的持久性 |
---|---|---|---|
乳腺发育和乳头/乳晕增大 | 2–6个月 | 1–3年 | 永久 |
胡须/体毛变稀疏/生长减缓 | 4–12个月 | >3年[c] | 可逆 |
男性模式脱发的停止/逆转 | 1–3个月 | 1–2年[d] | 可逆 |
皮肤变软/油质和痤疮减少 | 3–6个月 | 未知 | 可逆 |
脂肪组织以一种女性模式重新分布 | 3–6个月 | 2–5年 | 可逆 |
肌肉质量/力量下降 | 3–6个月 | 1–2年[e] | 可逆 |
骨盆变宽和变圆[f] | 不明确 | 不明确 | 永久 |
心境、情绪性和行为变化 | 不明确 | 不明确 | 可逆 |
性冲动减少 | 1–3个月 | 3–6个月 | 可逆 |
自发性/夜间阴茎勃起减少 | 1–3个月 | 3–6个月 | 可逆 |
勃起功能障碍和少精液症 | 1–3个月 | 多变 | 可逆 |
精子产量/生育能力下降 | 未知 | >3年 | 可逆或永久[g] |
睾丸变小 | 3–6个月 | 2–3年 | 未知 |
阴茎变小 | 无[h] | 不存在 | 不存在 |
前列腺变小 | 不明确 | 不明确 | 不明确 |
声音变化 | 无[i] | 不存在 | 不存在 |
脚注和来源
脚注:
|
参考文献
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