A Quality Improvement project on Gender Affirming Hormone Therapy for transgender patients in a rural Vermont clinic

A Quality Improvement project on Gender Affirming Hormone Therapy for transgender patients in a rural Vermont clinicA Quality Improvement project on Gender Affirming Hormone Therapy for transgender patients in a rural Vermont clinic that provided protocols and consent forms for masculining therapy to the practitioners at that clinic who wish to prescribe gender affirming hormone therapy (GAHT)https://scholarworks.uvm.edu/fmclerk/1843/thumbnail.jp

Insurance coverage for gender-affirming hormone therapy

Medical Schoolhttps://deepblue.lib.umich.edu/bitstream/2027.42/148203/1/woodricks.pd

Effect of Hormone Replacement Therapy on Bone Health and Density in Transgender Individuals

Background: This article is an examination of the effects of hormone replacement therapy on bone health and density in transgender individuals. The use of gender affirming hormone therapy and surgery is on the rise nationally. This bears the question: what side effects may result from use? Hormones have previously been studied for their protective effects on bone health, but there is a distinct lack of research into the effects of long-term gender-affirming hormone therapy. Objective: To answer the research question: What effect does gender-affirming hormone therapy have on bone density in adult and adolescent transgender individuals over at least a 12-month period. Design: Scoping literature review utilizing sources from January 2011 to September 2022. The academic databases used in the collection of sources include PubMed and CINAHL Complete. Participants/Setting: Studies selected must have participants that identify as transgender and currently be receiving, or have previously received, gender-affirming hormone therapy. Inclusion criteria for adolescent individuals was identical to adults, with the addition that they must be past Tanner Stage II in puberty. Main Outcome Measure: It was hypothesized that the use of estrogen therapy in individuals would have a protective effect on bone mineral density and health, whereas testosterone therapy would have a deleterious effect when used on its own. Results/Conclusion: The use of gender-affirming therapy in transgender individuals is recognized as safe for adults and adolescents. Estrogen therapy had a mostly protective effect on bone mineral density, which reduces fracture and osteoporosis risk. Testosterone therapy had less effect on bone mineral density. While there were some incidences of bone mineral density growth, overall testosterone had a neutral effect on bone health. In adolescents, GnHR agonists were the primary treatment and resulted a in decrease of bone mineral density. This deleterious effect was lessened with the addition of sex hormones

Transgender adults, gender-affirming hormone therapy and blood pressure: a systematic review

Objectives: Gender-affirming hormone therapy (GHT) is utilized by people who are transgender to align their secondary sex characteristics with their sex identity. Data relating to cardiovascular outcomes in this population are limited. We aimed to review the impact of GHT on the blood pressure (BP) of transgender individuals. Methods: We searched PubMed/MEDLINE, SCOPUS and Cochrane Library databases for articles published relating to the BP of transgender adults commencing GHT. Methodological quality was assessed via the ‘Quality Assessment Tool for Before–After (Pre–Post) Studies with No Control Group’. Results: Six hundred articles were screened, of which 14 studies were included in this systematic review encompassing 1309 individuals (∼50% transgender men and women) treated with GHT between 1989 and 2019. These articles were all pre–post observational studies without control groups. Mean ages ranged between 23.0–36.7 years (transgender men) and 25.2–34.8 years (transgender women). Interventions were diverse and included oral, transdermal and injectable hormonal preparations with 4 months to 5 years follow-up. Most studies in transgender men did not demonstrate a change in BP, whereas transgender women on GHT demonstrated an increase in SBP but not DBP. These studies were heterogenous with significant methodological limitations and only two were determined to have a good quality rating. Conclusion: There is currently insufficient data to advise the impact of GHT on BP in transgender individuals. Better quality research is essential to elucidate whether exogenous sex hormones modulate BP in transgender people and whether this putative alteration infers poorer cardiovascular outcomes

Gender-affirming hormone therapy, vascular health and cardiovascular disease in transgender adults

Gender-affirming or cross-sex hormone therapy is integral to the management of transgender individuals yet our appreciation of the effects of such hormones on cardiovascular health is limited. Insights into vascular pathophysiology and outcomes in transgender people receiving sex steroids could be fundamental in providing better care for this population through the management of cardiovascular risk and more broadly advance our understanding of the role of sex and gender in vascular health and disease. In addition, there is a need to understand how gender-affirming hormone therapy impacts cardiovascular disease risk and events as transgender individuals age. This review explores the available evidence on the associations between gender-affirming hormones and cardiovascular events such as coronary artery disease, stroke, hypertension, thrombosis, lipid abnormalities, and diabetes mellitus. Current research about vascular outcomes in adults receiving hormonal therapy is limited by the absence of large cohort studies, lack of appropriate control populations, and inadequate data acquisition from gender identity services. Existing epidemiological data suggest that the use of estrogens in transgender females confers an increased risk of myocardial infarction and ischemic stroke. Conversely, transgender males receiving testosterone lack any consistent or convincing evidence of increased risk of cardiovascular or cerebrovascular disease. Further studies are required to confirm whether such risk exists and the mechanisms by which they occur

Reproductive Health And Fertility Among Transgender Adolescents: A Knowledge And Attitudes Survey

The goal of this study was to determine the knowledge and attitudes of transgender adolescents regarding fertility and future parenthood. We developed and administered a cross-sectional questionnaire to a convenience sample of 23 transgender and gender non-conforming adolescents (mean age 16.2 ± 2.6) who attended the Yale Pediatric Gender Program between October 2016 and August 2017. Our results indicate that transgender adolescents have a basic understanding of reproductive health and fertility (mean total knowledge score of 3.78 ± 0.80 out of 5). Knowledge scores were significantly higher in participants with previous information about gender-affirming hormone therapy (GAH;

The Effect of Delayed Access to Gender Affirming Hormone Therapy on the Mental Health of Transgender Patients

Purpose/Objective: Transgender (TG) people make up approximately 0.5% of the United States’ population and face barriers in healthcare. Not all TG people desire gender affirming hormone therapy (GAHT), but those who do may struggle to find a prescriber and face delays in receiving care. This paper explores the mental health impact of delayed access to GAHT on TG patients. Methods: PubMed, Medline, and Cochrane were searched using the keywords “transgender”, “gender affirming hormone therapy”, and “mental health”. A separate search string replaced “mental health” with “education” to find articles related to clinician education on GAHT. Results: TG participants not on GAHT had significantly worse depression and anxiety than cisgender people, but after six months of GAHT, depression and anxiety were comparable to the general population. TG patients on GAHT had significantly improved depression and anxiety compared to before they started GAHT and TG patients waiting to start GAHT. Depression, psychopathology, body uneasiness, and gender dysphoria improved with GAHT. A one-hour lecture on GAHT for medical students significantly increased familiarity with GAHT, which may increase future likelihood of prescribing it and improve access. Conclusions: TG patients waiting for GAHT have poorer mental health than TG patients on GAHT and the general population, but within six months of starting GAHT, there is no significant difference in depression or anxiety in TG people than cisgender people. TG patients with diagnosed gender dysphoria should not face delays in initiating GAHT. Improved access to GAHT requires more prescribers, so GAHT needs to be a required topic for clinicians to reduce health disparities for TG patients

Health considerations for transgender women and remaining unknowns : a narrative review

Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address