1932

Abstract

Transgender people often face barriers in health care due to lack of access to care, lack of knowledgeable healthcare professionals, discrimination, and gaps in medical and mental health research. Existing research on transgender health has focused heavily on mental health, HIV/AIDS, sexually transmitted diseases/infections, and substance abuse. Gender-affirming hormone therapy and/or surgery allows for some alignment of biology and gender identity. Gender-affirming care may offer quality-of-life benefits, which may outweigh modest concerns related to exogenous hormone therapy. The Endocrine Society treatment guidelines were revised in 2017, and this article reviews recent data that might inform a future guideline revision. Future longitudinal research is needed to close the gap in knowledge in the field of transgender medicine.

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/content/journals/10.1146/annurev-med-020222-121106
2023-01-27
2024-06-17
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Literature Cited

  1. 1.
    Hembree WC, Cohen-Kettenis PT, Gooren L et al. 2017. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 102:113869–903
    [Google Scholar]
  2. 2.
    Herman JL, Flores AR, O'Neill KK 2022. How many adults and youth identify as transgender in the United States? Rep., Williams Inst., Univ. Calif., Los Angeles.. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-Pop-Update-Jun-2022.pdf. Accessed Nov. 15, 2022
    [Google Scholar]
  3. 3.
    Safer JD. 2021. Research gaps in medical treatment of transgender/nonbinary people. J. Clin. Investig. 131:4e142029
    [Google Scholar]
  4. 4.
    Feldman J, Brown GR, Deutsch MB et al. 2016. Priorities for transgender medical and healthcare research. Curr. Opin. Endocrinol. Diabetes Obes. 23:2180–87
    [Google Scholar]
  5. 5.
    Abeln B, Love R. 2019. Bridging the gap of mental health inequalities in the transgender population: the role of nursing education. Issues Mental Health Nurs. 40:6482–85
    [Google Scholar]
  6. 6.
    Fernández Rodríguez M, Menéndez Granda M, Villaverde González A. 2018. Gender incongruence is no longer a mental disorder. J. Mental Health Clin. Psychol. 2:6–8
    [Google Scholar]
  7. 7.
    Safer JD, Tangpricha V. 2019. Care of the transgender patient. Ann. Intern. Med. 171:ITC1–ITC16
    [Google Scholar]
  8. 8.
    Goossens GH. 2021. The impact of hormone therapy on cardiometabolic risk factors in trans persons: implications and future perspectives. J. Clin. Endocrinol. Metab. 107:2e877–79
    [Google Scholar]
  9. 9.
    T'Sjoen G, Arcelus J, Gooren L et al. 2019. Endocrinology of transgender medicine. Endocr. Rev. 40:97–117
    [Google Scholar]
  10. 10.
    Tebbens M, Heijboer AC, T'Sjoen G et al. 2022. The role of estrone in feminizing hormone treatment. J. Clin. Endocrinol. Metab. 107:2e458–66
    [Google Scholar]
  11. 11.
    Wiik A, Lundberg TR, Rullman E et al. 2020. Muscle strength, size, and composition following 12 months of gender-affirming treatment in transgender individuals. J. Clin. Endocrinol. Metab. 105:3e805–13
    [Google Scholar]
  12. 12.
    Harper J, O'Donnell E, Sorouri Khorashad B et al. 2021. How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation. Br. J. Sports Med. 55:15865–72
    [Google Scholar]
  13. 13.
    Reisman T, Goldstein Z, Safer JD. 2019. A review of breast development in cisgender women and implications for transgender women. Endocr. Pract. 25:121338–45
    [Google Scholar]
  14. 14.
    de Blok CJM, Dijkman BAM, Wiepjes CM et al. 2021. Sustained breast development and breast anthropometric changes in 3 years of gender-affirming hormone treatment. J. Clin. Endocrinol. Metab. 106:2e782–90
    [Google Scholar]
  15. 15.
    Iwamoto SJ, T'Sjoen G, Safer JD et al. 2019. Letter to the Editor: Progesterone is important for transgender women's therapy—applying evidence for the benefits of progesterone in ciswomen. J. Clin. Endocrinol. Metab. 104:83127–28
    [Google Scholar]
  16. 16.
    Igo J, Visram H. 2021. Progesterone therapy use and safety in male to female transgender patients. Can. J. Diabetes 45:7 Suppl.S39
    [Google Scholar]
  17. 17.
    Slack DJ, Safer JD. 2021. Cardiovascular health maintenance in aging individuals: the implications for transgender men and women on hormone therapy. Endocr. Pract. 27:163–70
    [Google Scholar]
  18. 18.
    Zucker R, Reisman T, Safer JD. 2021. Minimizing venous thromboembolism in feminizing hormone therapy: applying lessons from cisgender women and previous data. Endocr. Pract. 27:6621–25
    [Google Scholar]
  19. 19.
    Klaver M, van Velzen D, de Blok C et al. 2022. Change in visceral fat and total body fat and the effect on cardiometabolic risk factors during transgender hormone therapy. J. Clin. Endocrinol. Metab. 107:1e153–64
    [Google Scholar]
  20. 20.
    Kozato A, Fox GWC, Yong PC et al. 2021. No venous thromboembolism increase among transgender female patients remaining on estrogen for gender-affirming surgery. J. Clin. Endocrinol. Metab. 106:41586–90
    [Google Scholar]
  21. 21.
    Safer JD, Tangpricha V. 2019. Care of transgender persons. N. Engl. J. Med. 381:2451–60
    [Google Scholar]
  22. 22.
    Moravek MB, Kinnear HM, George J et al. 2020. Impact of exogenous testosterone on reproduction in transgender men. Endocrinology 161:3bqaa014
    [Google Scholar]
  23. 23.
    Pirtea P, Ayoubi JM, Desmedt S, T'Sjoen G. 2021. Ovarian, breast, and metabolic changes induced by androgen treatment in transgender men. Fertility Sterility 116:4936–42
    [Google Scholar]
  24. 24.
    Roberts TA, Smalley J, Ahrendt D. 2020. Effect of gender affirming hormones on athletic performance in trans women and trans men: implications for sporting organisations and legislators. . Br. J. Sports Med. 55:11577–83
    [Google Scholar]
  25. 25.
    Madsen MC, van Dijk D, Wiepjes CM et al. 2021. Erythrocytosis in a large cohort of trans men using testosterone: a long-term follow-up study on prevalence, determinants, and exposure years. J. Clin. Endocrinol. Metab. 106:61710–17
    [Google Scholar]
  26. 26.
    Greenwald P, Dubois B, Lekovich J et al. 2022. Successful in vitro fertilization in a cisgender female carrier using oocytes retrieved from a transgender man maintained on testosterone. AACE Clin. Case Rep. 8:119–21
    [Google Scholar]
  27. 27.
    Crissman HP, Stroumsa D, Kobernik EK, Berger MB. 2019. Gender and frequent mental distress: comparing transgender and non-transgender individuals’ self-rated mental health. J. Women's Health 28:2143–51
    [Google Scholar]
  28. 28.
    Baker KE, Wilson LM, Sharma R et al. 2021. Hormone therapy, mental health, and quality of life among transgender people: a systematic review. . J. Endocr. Soc. 5:4bvab011
    [Google Scholar]
  29. 29.
    Hontscharuk R, Alba B, Hamidian Jahromi A, Schechter L 2021. Penile inversion vaginoplasty outcomes: complications and satisfaction. Andrology 9:61732–43
    [Google Scholar]
  30. 30.
    Hirschmann J, Kozato A, Sharma V et al. 2020. An analysis of chaplains’ narrative chart notes describing spiritual care visits with gender affirmation surgical patients. Transgender Health 7:192–100
    [Google Scholar]
  31. 31.
    Huber S, Ferrando C, Safer JD et al. 2021. Development and validation of urological and appearance domains of the post-Affirming Surgery Form and Function Individual Reporting Measure (AFFIRM) for transwomen following genital surgery. J. Urol. 206:61445–53
    [Google Scholar]
  32. 32.
    Bustos VP, Bustos SS, Mascaro A et al. 2021. Regret after gender-affirmation surgery: a systematic review and meta-analysis of prevalence. Plast. Reconstr. Surg. Glob. Open 9:3e3477
    [Google Scholar]
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