Health disparities in transgender people

Abstract

Transgender and gender diverse people often seek medical therapies to better align their bodies with their gender identity. 1 Hembree WC Cohen-Kettenis PT Gooren L et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102: 3869-3903 Crossref PubMed Scopus (870) Google Scholar These medical therapies typically include gender-affirming hormone therapy and gender-affirming surgeries. 1 Hembree WC Cohen-Kettenis PT Gooren L et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102: 3869-3903 Crossref PubMed Scopus (870) Google Scholar For transgender women, gender-affirming hormone therapy consists of oestrogen in combination with a testosterone-lowering medication. 1 Hembree WC Cohen-Kettenis PT Gooren L et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102: 3869-3903 Crossref PubMed Scopus (870) Google Scholar For transgender men, gender-affirming hormone therapy consists of testosterone. 1 Hembree WC Cohen-Kettenis PT Gooren L et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102: 3869-3903 Crossref PubMed Scopus (870) Google Scholar Guidelines from professional societies, such as the Endocrine Society, help with prescribing and monitoring the efficacy and safety of gender-affirming hormone therapy. 1 Hembree WC Cohen-Kettenis PT Gooren L et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102: 3869-3903 Crossref PubMed Scopus (870) Google Scholar The strategy is considered to be safe under appropriate medical supervision when following the Endocrine Society guidelines to ensure that the sex hormone concentrations do not exceed or go below the concentrations expected for men and women. 1 Hembree WC Cohen-Kettenis PT Gooren L et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102: 3869-3903 Crossref PubMed Scopus (870) Google Scholar , 2 Weinand JD Safer JD Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals. J Clin Transl Endocrinol. 2015; 2: 55-60 Crossref PubMed Scopus (106) Google Scholar Although studies indicate that gender-affirming hormone therapy is safe in the short term, less is known about the long-term risks. 2 Weinand JD Safer JD Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals. J Clin Transl Endocrinol. 2015; 2: 55-60 Crossref PubMed Scopus (106) Google Scholar , 3 Wierckx K Van Caenegem E Schreiner T et al. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence. J Sex Med. 2014; 11: 1999-2011 Summary Full Text Full Text PDF PubMed Scopus (166) Google Scholar Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoriaThis observational study showed an increased mortality risk in transgender people using hormone treatment, regardless of treatment type. This increased mortality risk did not decrease over time. The cause-specific mortality risk because of lung cancer, cardiovascular disease, HIV-related disease, and suicide gives no indication to a specific effect of hormone treatment, but indicates that monitoring, optimising, and, if necessary, treating medical morbidities and lifestyle factors remain important in transgender health care. Full-Text PDF