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Selective Estrogen Receptor Modulators: A Potential Option For Non-Binary Gender-Affirming Hormonal Care?

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posted on 2021-08-03, 03:04 authored by Jane Y Xu, Michele A O'Connell, Lauren Notini, Ada S Cheung, Savannah Zwickl, Ken C Pang
Gender dysphoria describes the distress associated with having a gender identity that differs from one’s birth-assigned sex. To relieve this distress, transgender, and gender diverse (henceforth, trans) individuals commonly undergo medical transition involving hormonal treatments. Current hormonal treatment guidelines cater almost exclusively for those who wish to transition from male to female or vice versa. In contrast, there is a dearth of hormonal options for those trans individuals who identify as non-binary and seek an androgynous appearance that is neither overtly male nor female. Though prolonged puberty suppression with gonadotrophin releasing hormone agonists (GnRHa) could in theory be gender-affirming by preventing the development of unwanted secondary sex characteristics, this treatment option would be limited to pre- or peri-pubertal adolescents and likely have harmful effects. Here, we discuss the theoretical use of Selective Estrogen Receptor Modulators (SERMs) for non-binary people assigned male at birth (AMAB) who are seeking an androgynous appearance through partial feminization without breast growth. Given their unique range of pharmacodynamic effects, SERMs may represent a potential gender-affirming treatment for this population, but there is a lack of knowledge regarding their use and potentially adverse effects in this context.


KP is supported by fellowships from the Royal Children's Hospital Foundation and Hugh Williamson Trust Foundation. AC is supported by an Australian Government National Health and Medical Research Council Early Career Fellowship (#1143333) and receives support from the Viertel Charitable Foundation Clinical Investigator Award, Endocrine Society of Australia KenWynne Award and Royal Australasian College of Physicians Foundation. MO'C, LN, and KP acknowledge the infrastructure funding received from the Victorian State Government through the Operational Infrastructure Support (OIS) Program.


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