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Endocrinology, Hormone Replacement Therapy (HRT), and Aging

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Transgender and Gender Nonconforming Health and Aging

Abstract

Hormone replacement therapy (HRT) protocols for older transgender and gender nonconforming (TGNC) people are based on existing standards of care for TGNC adults and clear frameworks for how to conduct patient assessments for initiation of HRT. However, biomedical interventions and practice recommendations for gender-affirming HRT for older TGNC adults are not comprehensively or explicitly described. Practice recommendations herein examine assessment, risk, benefit, and treatment for older TGNC adults including utilization of shared clinical decision-making with patients and use of informed consent models. Also recommended is utilization of a biopsychosocial approach that examines the impact of life course events, experiences, and HRT intervention on the dimensions of successful aging. Medical management of HRT is well within the scope of primary care and often is a minor addition to the TGNC individual’s clinical care. Few long-term health conditions pose an absolute contraindication to initiation of HRT, and hormone treatment modalities are well-tolerated by older TGNC adults when combined with medical management of multiple chronic conditions of aging.

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References

  1. Adkins BD, Barlow AB, Coogan AC, Desouki MM, Jack A, Schultenover SJ, Weiss VL. Characteristic findings of cervical Papanicolaou tests from transgender patients on androgen therapy: challenges in detecting dysplasia. Cytopathology. 2018;29:281. https://doi.org/10.1111/cyt.12525.

    Book  Google Scholar 

  2. American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46. https://doi.org/10.1111/jgs.13702.

    Article  Google Scholar 

  3. Arnold JD, Sarkodie EP, Coleman ME, Goldstein DA. Incidence of venous thromboembolism in transgender women receiving oral estradiol. J Sex Med. 2016;4(5):1241–6.

    Google Scholar 

  4. Babb SD, Gentzke AS, Jamal A, Phillips E, Homa DM, King BA, Neff LJ. Current cigarette smoking among adults — United States, 2016. Morb Mortal Wkly Rep. 2018;67:53–9. https://doi.org/10.15585/mmwr.mm6702a1.

    Article  Google Scholar 

  5. Baker KE. The future of transgender coverage. N Engl J Med. 2017;376(19):1801–4.

    Article  Google Scholar 

  6. Bergendal A, Kieler H, Sundström A, Lindén Hirschberg A, Kocoska-Maras L. Risk of venous thromboembolism associated with local and systemic use of hormone therapy in peri- and postmenopausal women and in relation to type and route of administration. Menopause. 2016;1:593. https://doi.org/10.1097/GME.0000000000000611.

    Article  Google Scholar 

  7. Bjerrum L, Andersen M, Petersen G, Kragstrup J. Exposure to potential drug interactions in primary health care. Scand J Prim Health Care. 2003;21(3):153–8.

    Article  Google Scholar 

  8. Bidwell, et al. Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults. Transgend Health. 2017;2(1):156–64. https://doi.org/10.1089/trgh.2017.0028.

    Article  Google Scholar 

  9. Buchting FO, Emory KT, Scout, Kim Y, Fagan P, Vera LE, Emery S. Transgender use of cigarettes, cigars, and E-cigarettes in a national study. Am J Prev Med. 2017;53(1):e1–7. https://doi.org/10.1016/j.amepre.2016.11.022. Epub 2017 Jan 13

    Article  PubMed  PubMed Central  Google Scholar 

  10. Canonico M, Plu-Bureau G, Lowe GD, Scarabin PY. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. 2008;336(7655):1227–31.

    Article  Google Scholar 

  11. Centers for Disease Control and Prevention. Diagnoses of HIV infection among adults aged 50 years and older in the United States and dependent areas, 2010–2014. HIV Surveillance Supplemental Report 2016;21(2) http://wwwcdcgov/hiv/library/reports/surveillance/. Published May 2016. Accessed May 21, 2018.

  12. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend. 2012;13(4):165–232.

    Article  Google Scholar 

  13. Deutsch MB. Use of the informed consent model in the provision of cross-sex hormone therapy: a survey of the practices of selected clinics. Int J Transgend. 2012;13(3):140–6.

    Article  Google Scholar 

  14. Deutsch MB. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2nd ed. San Francisco: Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California; 2016. Available at: www.transhealth.ucsf.edu/.

  15. Ettner R. Care of the elderly transgender patient. Curr Opin Endocrinol Diabetes Obes. 2013;20(6):580–4. https://doi.org/10.1097/01.med.0000436183.34931.a5.

    Article  Google Scholar 

  16. Fabbre VD. Gender transitions in later life: a queer perspective on successful aging. Gerontologist. 2015;55(1):144–53. https://doi.org/10.1093/geront/gnu079. Epub 2014 Aug 26

    Article  Google Scholar 

  17. Feldman J. Medical and surgical management of the transgender patient: What the primary care clinician needs to know. In: World Professional Association for Transgender Health (WPATH), editor. Standards of care for the health of transsexual, transgender, and gender nonconforming people. 7th ed; 2009. p. 365–91.

    Google Scholar 

  18. Feldman J. Medical and surgical management of the transgender patient: what the primary care clinician needs to know. The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. 2nd ed. Philadelphia: American College of Physicians; 2015.

    Google Scholar 

  19. Feldman J, Safer J. Hormone therapy in adults: suggested revisions to the sixth version of the standards of care. Int J Transgend. 2009;11(3):146–82. https://doi.org/10.1080/15532730903383757.

    Article  Google Scholar 

  20. Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States? The Williams Institute. 2016. Published Web Location. http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgenderin-the-United-States.pdf.

  21. Gamarel KE, Mereish EH, Manning D, Iwamoto M, Operario D, Nemoto T. Minority stress, smoking patterns, and cessation attempts: findings from a community-sample of transgender women in the San Francisco Bay Area. Nicotine Tob Res. 2016;18(3):306–13. https://doi.org/10.1093/ntr/ntv066

    Article  Google Scholar 

  22. Giltay EJ, Gooren LJ, Wierckx K. Cardiovascular disease in transsexual persons treated with cross-sex hormones: reversal of the traditional sex difference in cardiovascular disease pattern. Eur J Endocinol. 2014;170(6):809–19. https://doi.org/10.1530/EJE-14-0011. Epub 2014 Mar 10

    Article  CAS  Google Scholar 

  23. Golds G, Houdek D, Arnason T. Male hypogonadism and osteoporosis: the effects, clinical consequences, and treatment of testosterone deficiency in bone health. Int J Endocrinol. 2017; https://doi.org/10.1155/2017/4602129. Epub 2017 Mar 16

    Article  Google Scholar 

  24. Goodman MP. Are all estrogens created equal? A review of oral vs. transdermal therapy. J Womens Health (Larchmt). 2012;21(2):161–9. https://doi.org/10.1089/jwh.2011.2839.

    Article  Google Scholar 

  25. Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869–903. https://doi.org/10.1210/jc.2017-01658.

    Article  Google Scholar 

  26. Hermosura AT, Kabigting FD. Dermatologic care of the transgender patient. Dermatol Online J. 2016;22:10.

    Google Scholar 

  27. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 U.S. transgender survey. Washington, DC: National Center for Transgender Equality; 2016.

    Google Scholar 

  28. Jin K. Modern biological theories of aging. Aging and Disease. 2010;1(2):72–4.

    PubMed  PubMed Central  Google Scholar 

  29. Joint R, Chen ZE, Cameron S. Breast and reproductive cancers in the transgender population: a systematic review. BJOG (An International Journal of Obstetrics & Gynaecology). 2018; https://doi.org/10.1111/1471-0528.15258.

    Article  CAS  Google Scholar 

  30. Jones BA, Brewin N, Richards C, Van Eijk M, Stephenson-Allen A, Arcelus J. Investigating the outcome of the initial assessment at a national transgender health service: Time to review the process? Int J Transgenderism. 2017;18(4):427–32.

    Article  Google Scholar 

  31. Knochel KA. Are they prepared? A look at midlife transgender people and their anticipated adaptation to aging. Minneapolis: University of Minnesota; 2011.

    Google Scholar 

  32. Maraka S, Singh Ospina N, Rodriguez-Gutierrez R, Davidge-Pitts CJ, Nippoldt TB, Prokop LJ, Murad MH. Sex steroids and cardiovascular outcomes in transgender individuals: a systematic review and meta-analysis. J Clin Endocrinol Metabol. 2017;102(11):3914–23.

    Article  Google Scholar 

  33. New York State Department of Health AIDS Institute (NYSDOH). Older adults and sexual health: a guide for aging services providers. 2017. https://aging.ny.gov/nysofa/Older%20Adults%20Sexual%20Health%20Guide%202017%20WEB%20version.pdf.

  34. Proctor K, Haffer SC, Ewald E, Hodge C, James CV. Identifying the transgender population in the Medicare program. Transgender Health. 2016;1(1):250–65. https://doi.org/10.1089/trgh.2016.0031.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Rhoden EL, Morgentaler A. Testosterone replacement therapy in hypogonadal men at high risk for prostate cancer: results of 1 year of treatment in men with prostatic intraepithelial neoplasia. J Urol. 2003;170(6):2348–51.

    Article  CAS  Google Scholar 

  36. Richards C, Bouman WP, Seal L, Barker MJ, Nieder TO, T’Sjoen G. Non-binary or genderqueer genders. Int Rev Psychiatry. 2016;28(1):95–102.

    Article  Google Scholar 

  37. Russell S, More F. Addressing health disparities via coordination of care and interprofessional education: lesbian, gay, bisexual, and transgender health and oral health care. Dental Clinics. 2016;60(4):891–906.

    Article  Google Scholar 

  38. Sabra JJ, Fang CX, Kundu RV. A knowledge-based assessment of dermatological care for transgender women. Transgender Health. 2018;3(1):71–3.

    Article  Google Scholar 

  39. Safer JD, Weinand JD. Hormone therapy in transgender adults is safe with provider supervision; a review of hormone therapy sequelae for transgender individuals. J Clin Transl Endocrinol. 2015;2(2):55–60.

    PubMed  PubMed Central  Google Scholar 

  40. Schick V, Herbenick D, Reece M, Sanders SA, Dodge B, Middlestadt SE, Fortenberry JD. Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. J Sex Med. 2010;7(s5):315–29.

    Article  Google Scholar 

  41. Schulz SL. The informed consent model of transgender care: an alternative to the diagnosis of gender dysphoria. First published Dec 13, 2017. Research Article. https://doi.org/10.1177/0022167817745217.

    Article  Google Scholar 

  42. Wierckx K, Mueller S, Weyers S, Van Caenegem E, Roef G, Heylens G, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med. 2012 Oct 1;9(10):2641–51.

    Article  CAS  Google Scholar 

  43. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288(3):321–33.

    Article  Google Scholar 

  44. Wylie K, Knudson G, Khan SI, Bonierbale M, Watanyusakul S, Baral S. Serving transgender people: clinical care considerations and service delivery models in transgender health. Lancet. 2016;388(10042):401–11.

    Article  Google Scholar 

  45. Zevin B, Deutsch MB. Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco. In: Deutsch MB, editors. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2nd ed. 2016. Available at www.transhealth.ucsf.edu/guidelines.

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Correspondence to Magda Houlberg .

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Appendix A: Medication Prescribing and Dosage Resources

Appendix A: Medication Prescribing and Dosage Resources

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Houlberg, M. (2019). Endocrinology, Hormone Replacement Therapy (HRT), and Aging. In: Hardacker, C., Ducheny, K., Houlberg, M. (eds) Transgender and Gender Nonconforming Health and Aging. Springer, Cham. https://doi.org/10.1007/978-3-319-95031-0_2

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  • DOI: https://doi.org/10.1007/978-3-319-95031-0_2

  • Publisher Name: Springer, Cham

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