Transgender women may decide to use more easily available and less costly interventions such as subcutaneous injection of silicone (often industrial grade), mineral oil, or petroleum jelly into the face, chest, hips, thighs, and buttocks to achieve a more feminine appearance. The silicone injections are often provided by nonlicensed practitioners,  using nonsterile technique during “pumping”  parties, where many people often share available materials. Adverse effects of subcutaneous silicone injection include local reactions, skin infections, fibrosis, and deformity.

Serious outcomes include respiratory failure and death due to Pulmonary embolism. Complications also may include infections related to blood-borne pathogens such as hepatitis B, hepatitis C, and HIV.

Few studies have been undertaken to study the long-term effects of cross-gender hormone therapy. A study conducted in the Netherlands investigating the outcomes of hormonal therapy in 2,236 male-to-female and 876 female-to-male transsexuals did not reveal an increase in cardiovascular or cancer-related mortality.[56] Further studies, especially prospective studies, need to be conducted to further assess health issues related to medical transition. The USPSTF does not include specific guidelines for persons of transgender experience. Most clinicians who treat transgender people advise that preventive screenings continue depending on a person’s hormonal and surgical status. A comprehensive summary of best practice guidelines is available from the Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health.[57]

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Anita Radix, MD, MPhil, MPH, and Gal Mayer, MD, MS

Anita Radix, MD, MPhil, MPH, Director of Research and Education, Callen-Lorde Community Health Center
Dr. Gal Mayer MD practices internal medicine in New York, New York. Callen Lorde Community Health Center

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REFERENCES

1. The Gay and Lesbian Medical Association. Healthy People 2010 companion document for LGBT Health.
2. Solarz AL,  Institute of Medicine,  eds.  Lesbian Health:  Current Assessment and Directions for the Future. 1st ed. Washington, DC: National Academies Press; 1999.
3. Dean L, Meyer I, Robinson K, Sell R, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2000;4(3):101-151.
4. Laumann E, Gagnon J, Michael R, Michaels S. The Social Organization of Sex: Sexual Practices in the United States. Chicago, IL: University of Chicago Press; 1994.
5. Pathela P, Hajat A, Schillinger J, Blank S, Sell R, Mostashari F. Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City. Men Ann Intern Med. 2006;145:416-425.
6. Mosher W, Chandra A, Jones J. Sexual behavior and selected health measures: men and women 15-44 years of age,  United States,  2002.  Vital Health Stat. 2005;362:21-26.
7. Goodenow C, Szalacha L, Rubin L, Westheimer K. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Pub Health. 2008;98(6):1051-1058.

Full References  »