Endocrine Care in Transgender Adults: A Portuguese Perspective on Gender-Affirming Hormone Therapy

Gender-affirming hormone therapy (GAHT) plays a central role in the care of transgender individuals, with well-established benefits for psychological well-being and overall quality of life. This narrative review provides a structured overview of GAHT in adults, integrating international guidelines with the specific legal and healthcare context in Portugal. Portugal’s legal framework supports gender self-determination through a simplified recognition process. However, access to specialized care remains uneven, and unsupervised hormone use is not uncommon. Initial clinical evaluation prior to initiating GAHT should include a comprehensive medical history, individualized risk assessment, and baseline laboratory investigations. Feminizing and masculinizing hormone regimens are reviewed, highlighting expected physical changes, safety considerations, and treatment goals. Recommendations for follow-up and monitoring are provided, including assessment of cardiovascular risk, bone health, and relevant oncological screening. Fertility preservation and contraceptive counseling are addressed as essential components of care. Hormonal approaches for non-binary individuals and the importance of multidisciplinary collaboration are also briefly discussed. This review aims to support clinicians in providing safe, evidence-based, and respectful endocrine care to transgender adults, while acknowledging the specific challenges and opportunities within the Portuguese context.