Routine Screening for Transgender and Gender Diverse Adults Taking Gender-Affirming Hormone Therapy: a Narrative Review

Journal of General Internal Medicine (2021)Cite this article

ABSTRACT

Despite the growing number of adult transgender and gender diverse (TGD) patients seeking health services, there are many unknowns regarding how routine screening recommendations should be applied to TGD persons receiving gender-affirming hormone therapy (GAHT). Patients taking GAHT may have disease risks that differ from what is expected based on their sex assigned at birth or affirmed gender identity. We discuss two patient cases, one transgender man and one transgender woman who present for routine medical care, to review several conditions that may be impacted by the hormones utilized in masculinizing and feminizing GAHT and for which screening recommendations are available for TGD adults: cardiovascular risk factors, osteoporosis, breast cancer, cervical cancer, and prostate cancer. We reviewed the TGD-specific screening recommendations from several major medical organizations and programs and found them to be largely based upon expert opinion due to a lack of evidence. The goal of this narrative review is to assist healthcare professionals in counseling and screening their TGD patients when and where appropriate. Not all TGD adults have the ability or need to receive routine medical care from a specialized TGD health clinic; therefore, it is essential for all healthcare professionals involved in routine and gender-affirming care to have knowledge about these conditions and screenings.

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ACKNOWLEDGEMENTS

SJI was supported by an Advanced Fellowship in Geriatrics from the Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Office of Academic Affiliations, U.S. Department of Veterans Affairs. SJI receives funding through a National Institutes of Health/University of Colorado Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) K12 grant (supported by NIH 5 K12 HD057022-13, PIs: Regensteiner JG and Santoro NF).

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  1. Division of Endocrinology, Metabolism & Diabetes, Department of Medicine, University of Colorado, Anschutz Medical Campus, 12801 E 17th Ave, Aurora, CO, 80045, USA

    Sean J. Iwamoto MD & Micol S. Rothman MD

  2. Department of Endocrinology, Medicine Service, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, 80045, CO, USA

    Sean J. Iwamoto MD

  3. UCHealth Integrated Transgender Program, 80045, Aurora, CO, USA

    Sean J. Iwamoto MD & Micol S. Rothman MD

  4. Division of Gynecology, Department of Surgery, Boston Children’s Hospital, Boston, 02115, MA, USA

    Frances Grimstad MD, MS

  5. Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, 02215, MA, USA

    Michael S. Irwig MD

  6. Harvard Medical School, Boston, 02115, MA, USA

    Michael S. Irwig MD

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  1. Sean J. Iwamoto MD
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  2. Frances Grimstad MD, MS
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  3. Michael S. Irwig MD
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  4. Micol S. Rothman MD
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Correspondence to Sean J. Iwamoto MD.

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Prior Presentations: Presented as a mini-symposium at the U.S. Professional Association for Transgender Health 2019 Meeting in Washington, DC, on September 7, 2019.

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Iwamoto, S.J., Grimstad, F., Irwig, M.S. et al. Routine Screening for Transgender and Gender Diverse Adults Taking Gender-Affirming Hormone Therapy: a Narrative Review. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-021-06634-7

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KEY WORDS

  • transgender
  • screening
  • cardiovascular disease
  • osteoporosis
  • cancer