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Study stresses need for focus on hormone therapy for aging transgender women

Understanding the risks and benefits of gender-affirming hormone therapy (GAHT) for women in midlife and beyond is important because it’s estimated that nearly one-quarter (23%) of transgender women begin hormone therapy after the age of 40, with 12% beginning GAHT after age 50.

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An estimated 71% of transgender women use or intend to use gender-affirming hormone therapy (GAHT). Although sample sizes are comparatively small, there are studies that demonstrate psychological advantages of GAHT, whereas others suggest added health risks.

Understanding the risks and benefits of GAHT for women in midlife and beyond is important because it’s estimated that 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 improved mental health benefits and a feeling of overall well-being in transgender women using GAHT. 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.

Currently, there is no evidence to support the termination of GAHT in transgender women on the basis of age alone, although in most aging populations, there is concern about increased cardiovascular risk. In transgender women using GAHT who have cardiovascular risk factors, literature supports transdermal estradiol as the preferred route. Multivariable analyses demonstrate that transgender women experience myocardial infarction at approximately two times higher rates than cisgender women, and similar trends have been seen with ischemic stroke. Studies evaluating the risk of breast cancer in transgender women using GAHT have produced mixed results, largely because of limited sample sizes.

“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. Sarah Pickle from the University of Cincinnati College of Medicine.

In the end, healthcare professionals need guidance on how to best care for their transgender patients. And so, “more research specific to transgender populations is needed so that healthcare professionals can make treatment recommendations with greater confidence,” says Dr. Faubion, NAMS medical director.  

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