Abstract
Transgenders (TGs) are individuals with gender identity and behaviour different from the social norms; they often undergo gender-affirming hormone therapy (HT). HT for TG men involves testosterone treatment and, for TG women, oestrogen plus androgen-lowering agents. Due—but not limited—to the lifelong lasting HT, usually TG people experience several physical and behavioural conditions leading to different and specific susceptibility and vulnerability in comparison to general population, including the response to chemical contaminants present in daily life. In particular, the exposure to the widespread endocrine disrupters (EDs) may affect hormonal and metabolic processes, leading to tissue and organ damage. Since the endocrine system of TG people is overstimulated by HT and, often, the targets overlap with ED, it is reasonable to hypothesize that TG health deserves special attention. At present, no specific tools are available to study the toxicological effects of environmental contaminants, including EDs, and the potential long-term consequences of HT on TG people. In this context, the development of adequate and innovative animal models to mimic gender-affirming HT have a high priority, since they can provide robust data for hazard identification in TG women and men, leading to more reliable risk assessment.
Highlights
The word ‘transgender’ (TG) is used to describe individuals whose gender identity and behaviour not completely and/or permanently match the sex assigned at birth; they include gender-nonconforming people who may have a binary or nonbinary gender identity: binary, if they identify themselves as women or men, whereas nonbinary individuals reject to be considered exclusively in masculine or feminine gender [1,2]
Cancer risk may be altered in TG people receiving hormone therapy (HT), above all considering that th incidence of some types of cancer differs between men and women and some of thes differences are attributed to sex hormones [32]
It is interesting to notice that the structures of obesogenic endocrine disrupters (EDs) are mainly lipophilic and they have the ability to bioaccumulate in the adipose tissue, resulting in the exacerbation of their endocrine disrupting effects; since gender-affirming HT changes the body composition, as a consequence, it might modify the retention of lipophilic pollutants with a possible adverse action not yet studied
Summary
The word ‘transgender’ (TG) is used to describe individuals whose gender identity and behaviour not completely and/or permanently match the sex assigned at birth; they include gender-nonconforming people who may have a binary or nonbinary gender identity: binary, if they identify themselves as women (assigned male at birth) or men (assigned female at birth), whereas nonbinary individuals reject to be considered exclusively in masculine or feminine gender [1,2]. TG people undergo several physical and behavioural conditions—beyond HT—that may lead to different and specific susceptibility and vulnerability in comparison to the general population, including the response to chemical contaminants commonly present in daily life. In this respect, TG people may represent a susceptible sub-population group needing specific attention in the frame of risk assessment (RA), the scientific process aiming to identify and estimate the risks resulting from chemical or physical agents through all the possible routes of exposure [16]. No specific tools are available to study the toxicological effects of EDs and other environmental contaminants, as well as the potential long-term consequences of HT on TG people In this context, the development of adequate and innovative animal models to mimic gender-affirming HT therapies has a high priority. The present work aims to summarize the state of art on the main health problems encountered by TG people approaching HT, the available studies mimicking gender-affirming HT therapy and the scientific basis for the development and improvement of appropriate rodent models for the evaluation of the long-lasting and toxicological effects of genderaffirming HT, as a basis to drive a targeted RA for TG people
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