Hormone Therapy for Aging Transgender Women

Hormone Therapy for Aging Transgender Women

Just completing the 2022 North American Menopause Society meeting held in Atlanta, October 12-15. One of the many interesting talks dealt with the menopause symptoms and challenges of transgender women.

Hormone Therapy (HT) is confusing for cisgender women, but it can be even much more so for transgender women. Because they are transitioning from male to female, an estimated 71% of transgender women use or intend to use gender-affirming hormone therapy (GAHT). Doing so offers some important psychological advantages, but may also come with some added health risks.

One of the presentations, by Dr. Sarah Pickle of the University of Cincinnati College of Medicine, differentiated pros and cons of hormones for transgender women.

Nearly one-quarter (23%) of transgender women begin hormone therapy after the age of 40, with 12% beginning GAHT after age 50. Specific areas of focus include mental, cardiovascular, and breast health.

Multiple studies have confirmed that using GAHT improved mental health benefits and a feeling of overall well-being in transgender women. Data collected from the National Transgender Discrimination Study examined qualify-of-life outcomes in transgender women aged older than 60 years and found that those who recently initiated GAHT reported statistically higher quality-of-life scores than their age-matched peers who had not initiated GAHT.

In cisgender women, HT is often discontinued as the women go beyond age 60 years to reduce potential risks to the breasts and heart. In contrast, there is  presently no evidence to support discontinuing GAHT in transgender women on the basis of age alone. In transgender women using GAHT who have cardiovascular risk factors, literature supports transdermal estradiol as the preferred route, as it is in cisgender women. Studies do show that transgender women experience myocardial infarction at rates approximately twice as high as  cisgender women, and similar trends have been seen with ischemic stroke. This isn’t surprising since many years ago, the benefits of HT were considered so high that it was also given to men and studies surrounding that found similar negative results. Studies evaluating the risk of breast cancer in transgender women using GAHT have produced mixed results, largely because of limited sample sizes.

Dr. Pickle, from the University of Cincinnati College of Medicine, said, “For most transgender women and transfeminine persons, the well-documented benefits of gender-affirming hormone therapy largely outweigh potential risks. It is important for healthcare professionals to understand how to counsel patients and mitigate possible risks of hormone therapy while recognizing that transgender patients are more likely to have deleterious health effects from discrimination, marginalization, and lack of access to healthcare than they are from side effects of hormone therapy,” says Dr. Pickle.

As the number of transgender women increases, understanding how best to support them becomes increasingly important. It also points out that transgender women have special considerations related to both mental and physical health that both healthcare providers and businesses will need to increasingly be aware of. This is further described in the book, Working Through Menopause.

For more information or interviews on this or other topics related to midlife women, contact Dr. Mache Seibel.

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