[Gender-affirming hormone therapy: state of the art]

Gender incongruence affects approximately 0.6% of the population in Germany and, when accompanied by significant psychological distress, may constitute an indication for gender-affirming hormone therapy (GAHT). The increasing diversity of gender identity has led to a more individualized approach to hormone therapy. The decision to initiate treatment is based on the expected reduction in gender-related dysphoria due to hormonal treatment. Treatment is carried out in accordance with guidelines and is tailored to the wishes and goals of the person seeking treatment. Various estradiol preparations and antiandrogenic substances can be used to achieve feminization. Masculinizing therapy relies primarily on testosterone. For non-binary individuals, GAHT is usually administered at lower doses and typically focuses on specific aspects of gender alignment. The therapeutic effects usually develop slowly but can be irreversible and significant. Risks should be assessed in advance, and patients should be informed about potential adverse effects. Monitoring and adjustment of treatment take place at specified regular intervals. Adjustments and support throughout the course of treatment-ranging from fertility preservation to cancer screening-are key components of comprehensive care in patients undergoing GAHT. Although the evidence regarding GAHT has improved significantly in recent years, large-scale studies are still lacking for many aspects.