Introduction

Aromatisation is a key biological process that has significant implications in the field of gender-affirming care, particularly for transgender individuals undergoing hormone therapy. Understanding aromatisation, its effects, and how it is managed in gender-affirming treatments is crucial for both healthcare providers and individuals.

What is Aromatisation?

Aromatisation refers to the conversion of androgens (male hormones like testosterone) into estrogens (female hormones like estradiol) by the enzyme aromatase. This process occurs in various tissues, including fat, muscle, brain, and skin.

Importance in Gender-Affirming Care

• For Transfeminine Individuals: In the context of transfeminine hormone therapy, controlling aromatisation is crucial. While estrogen therapy elevates estrogen levels, the body’s existing testosterone can aromatise into additional estrogen. This can be beneficial but needs to be carefully monitored to maintain desired hormone levels.
• For Transmasculine Individuals: In transmasculine hormone therapy, where testosterone is administered, there’s a possibility of some of this testosterone converting to estrogen through aromatisation. Managing this process is important to achieve the desired masculinising effects and avoid unwanted feminising effects.

Effects of Aromatization

• In Transfeminine Therapy: Enhanced breast development, redistribution of body fat to a more feminine pattern, and potentially mood changes.
• In Transmasculine Therapy: Potential for maintaining higher levels of estrogen than desired, which might counteract some masculinising effects of testosterone.

Managing Aromatization in Therapy

• Medication Adjustments: Adjusting the dosage of estrogen or testosterone based on regular blood tests to ensure appropriate levels are achieved.
• Use of Aromatase Inhibitors: In some cases, especially for transmasculine individuals, aromatase inhibitors might be used to reduce the conversion of testosterone to estrogen.
• Lifestyle Factors: Body composition, including fat distribution, can affect the rate of aromatization. Attention to diet and exercise may be part of managing hormone levels.

Assessing High Estradiol Levels in Transmasculine Individuals

One of the challenges in gender-affirming care for transmasculine individuals involves determining the source of elevated estradiol levels. These higher levels could be caused by either residual ovarian estrogen production or to the aromatisation of administered testosterone into estrogen. Distinguishing between these two sources is crucial for tailoring effective treatment strategies.

Determining the Source of Estradiol

• Using Blockers: The initial step often involves the use of medications that block estrogen production, targeting the ovaries. This can help in determining if the ovaries are the primary source of the elevated estradiol.
• Monitoring Estradiol Levels: After the administration of blockers, estradiol levels are closely monitored. If there is a significant decrease, it indicates that ovarian production was contributing to the high levels.
• Using Aromatase Inhibitors: If, however, estradiol levels remain high despite the use of blockers, this suggests that aromatisation may be the predominant source. In such cases, aromatase inhibitors can be used. These inhibitors specifically target the aromatase enzyme, reducing the conversion of testosterone to estrogen.
• Ongoing Evaluation: It’s important to continuously evaluate hormone levels and symptoms. The efficacy of treatment adjustments, like the introduction of aromatase inhibitors, needs to be monitored through regular blood tests and clinical assessments.

Conclusion

Aromatisation is a naturally occurring process that plays a significant role in hormone therapy for transgender individuals. Understanding and managing aromatization is essential for effective gender-affirming care. Regular monitoring, personalized treatment plans, and a holistic approach considering both medical and lifestyle factors are key to managing the effects of aromatization. As with all aspects of gender-affirming care, decisions should be made in close collaboration with healthcare professionals who specialize in this field.