Patients with M / W-transformation require estrogen therapy. Before starting this treatment, it is recommended to measure the level of testosterone, prolactin, determine the parameters of the general and biochemical (fasting glucose, liver enzymes, lipid spectrum) blood test, coagulogram. It is necessary to find out the family history of malignant tumors of the mammary glands, to convince the patient of the need for constant self-control. As a rule, patients with transsexualism referring to the appointment of hormone therapy, young healthy people, however, it must be remembered that the burdened history of breast cancer, as well as the presence of prolactin-secreting pituitary adenomas are absolute contraindications for prescribing estrogen therapy.

As already mentioned, it is necessary to clearly explain to patients the possibility of hormone therapy and highlight the effects that can not be achieved with hormone therapy. Thus, the biological men who are prescribed estrogen treatment can expect the following results: an increase in breast size, some redistribution of adipose tissue with an approach to the forms of the female body, weakening of the upper body muscles, softening of the skin, reduction of hair growth on the body, reduction in size testicles, reducing the frequency and strength of erections. Most of these changes are reversible, although the enlargement of the mammary glands does not disappear completely after cessation of treatment. As a rule, the complete disappearance of the changes induced by the hormones of their biological sex is almost impossible to achieve. So, patients should not expect to change the proportions of the skeleton, a decrease in shoe size or height.

It should be borne in mind that the full manifestation of the influence of hormonal therapy on the physical appearance of patients may not be obvious during the first 2 years of hormonal therapy, and the fact that the response of the body’s tissues to the action of hormones may be limited by a factor such as heredity that cannot be overcome. even with increasing dosages.

It is necessary to inform patients about all side effects that may occur as a result of ongoing hormone therapy. Special attention should be paid to the fact that as a result of taking hormones, the ability to conceive occurs, and the removal of the genital organs leads to the disappearance of reproductive abilities. Biological men, especially those who at the time of initiation of therapy are not
 parents need to be informed about the possibility of saving sperm and encourage them to use the sperm bank before hormone therapy begins.

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