Gender-affirming hormone therapy in Portugal: knowledge, safety and adherence

Abstract

Background: More research is needed to understand the knowledge, experiences, safety, and adherence of individuals on gender-affirming hormone therapy (GAHT) for gender dysphoria treatment. Aim: To assess the knowledge of the Portuguese transgender population on GAHT about the therapy, examine the experiences of those who initiated it through the Portuguese National Health System, and evaluate the safety, monitoring and adherence to hormonal therapy. Methods: Cross-sectional study with Portuguese transgender adults who had hormonal therapy. Participants completed an original questionnaire that utilized an ordinal Likert-style scale that ranged from 0 (worst result) to 6 (best result) for most items. Descriptive statistics and non-parametric tests were used to analyze both categorical and continuous variables. The level of statistical significance was set at 0.05. Results: Participants’ knowledge on GAHT was rated with a median of 5 points, relying mostly on the internet for information. 14.1% felt insufficiently informed. 71.2% faced obstacles obtaining GAHT, with long waiting times being the most common. Feminizing therapy was significantly more expensive. Initial consultation was often with psychologists/sexologists, with endocrinologists commonly being the first providers of GAHT. 43.3% didn’t undergo informed consent and 11.3% had no pretreatment blood tests. Only 53.2% discussed fertility with medical professionals, and of those, only 8.0% opted for it. 79.6% regularly underwent routine analyses and 87.3% were followed up in medical appointments, mainly with an endocrinologist. 6.3% of participants discontinued therapy, mostly due to adverse effects and difficulty obtaining prescriptions. Discussion: Internet sources dominated as the main information channel for GAHT, emphasizing the importance of healthcare professionals guiding patients to reliable sources. Limited healthcare provider knowledge and access barriers were identified. Primary care physicians had limited involvement, raising safety concerns. Inadequate fertility counseling and follow-up in family medicine were found. Discontinuation of therapy and nonadherence highlighted the need for comprehensive care and monitoring.