Center of Excellence for Transgender Health Logo
University of California, San Francisco Logo

University of California, San Francisco | About UCSF | Search UCSF | UCSF Medical Center

Aging Issues: Special Considerations

Considerations for beginning or continuing hormone treatment in older patients

There is no set upper age limit for hormonal therapy. Trans male patients beginning hormones after age 40 generally will progress more slowly in exhibiting desired results. (Grade C)

Osteoporosis has been reported in both older transmen and transwomen, and is frequently associated with poor compliance with the hormone regimen. (Grade B)

Some patients prefer to stop hormonal therapy; for post-gonadectomy patients under age 50, this is not recommended due to bone loss, and potential symptoms similar to menopause in both transwomen and transmen. (Grade A, B, C)

Upper age limits that might preclude surgical interventions should be considered. There is currently no information about outcomes for older patients, and some surgeons impose upper age limits for specific procedures. Older trans people considering surgery should consult with surgeons to determine what physical readiness requirements might be advisable to be medically eligible for surgery. Anticipated recovery times may be longer.

Additional screenings to consider in older patients

  • Transwomen patients on feminizing hormone therapy: Mammograms are recommended for transwomen when patients have been using estrogen for at least 30 years AND are at least 50 years of age, unless there is a strong family history of early breast or ovarian cancer. (Grade C)
  • Follow USPSTF guidelines for prostate screening. PSA is not useful if patient is on estrogen. (Grade B)

  • Transmen without hysterectomy: Pelvic exams every 1-3 years for patients over age 40 or with a family history of uterine or ovarian cancer; increase to every year if polycystic ovarian syndrome (PCOS) (see MedlinePlus) is present. Consider hysterectomy and oophorectomy if the patient's health will not be adversely affected by surgery, or if the patient is unable to tolerate pelvic exams. (Grade B, C)
  • Transmen: Consider bone density screening if age > 60 and if taking testosterone for < 5-10 years; if taking testosterone for > 5-10 years, consider at age 50+, earlier if additional risk factors for osteoporosis are present; recommend supplemental calcium and vitamin D in accordance with current osteoporosis prevention guidelines to help maintain bone density. Note that this may be applied to transmen at ages younger than typical starting age for osteoporosis prevention treatment due to the unknown effect of testosterone on bone density. (Grade B, C)
  • Transmen stopping testosterone will experience loss of libido, hot flashes, loss of body hair, muscle tone, and weight redistribution in a female pattern. (Grade C)