Endocrinology, Hormone Replacement Therapy (HRT), and Aging

Abstract

Hormone replacement therapy (HRT) protocols for older transgender and gender nonconforming (TGNC) people are based on existing standards of care for TGNC adults and clear frameworks for how to conduct patient assessments for initiation of HRT. However, biomedical interventions and practice recommendations for gender-affirming HRT for older TGNC adults are not comprehensively or explicitly described. Practice recommendations herein examine assessment, risk, benefit, and treatment for older TGNC adults including utilization of shared clinical decision-making with patients and use of informed consent models. Also recommended is utilization of a biopsychosocial approach that examines the impact of life course events, experiences, and HRT intervention on the dimensions of successful aging. Medical management of HRT is well within the scope of primary care and often is a minor addition to the TGNC individual’s clinical care. Few long-term health conditions pose an absolute contraindication to initiation of HRT, and hormone treatment modalities are well-tolerated by older TGNC adults when combined with medical management of multiple chronic conditions of aging.