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Updated: Nov 9, 2025
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Establishment of Rat Models Mimicking Gender-affirming Hormone Therapies
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Longitudinal Changes in Hematologic Parameters Among Transgender People Receiving Hormone Therapy
Ana Antun1,2, Qi Zhang3, Shalender Bhasin4,5
1Emory University, School of Medicine, Atlanta, Georgia.
Journal of the Endocrine Society
|April 9, 2021
Summary
Gender-affirming hormone therapy significantly alters blood cell counts in transgender individuals. Transmasculine people on testosterone therapy show higher erythrocytosis rates, while transfeminine individuals experience anemia.
Area of Science:
- Endocrinology and Hematology
- Transgender Health Research
Background:
- Gender-affirming hormone therapy (HT) impacts erythropoiesis, a critical area in transgender health.
- Understanding these hematologic effects is vital for monitoring transgender individuals' health.
Purpose of the Study:
- To compare hematologic parameter changes, including erythrocytosis and anemia rates, in transgender individuals receiving HT versus cisgender controls.
- To evaluate the influence of hormone therapy on blood cell production in transgender populations.
Main Methods:
- A longitudinal observational study involving 559 transfeminine (TF) and 424 transmasculine (TM) participants compared to matched cisgender referents.
- Ascertainment of hormone therapy receipt via prescription data and analysis of hemoglobin (Hb) and hematocrit (Hct) levels over time.
- Comparison of erythrocytosis and anemia rates using adjusted hazard ratios and confidence intervals.
Main Results:
- Transfeminine individuals showed a trend of decreasing Hb and Hct levels.
- Transmasculine individuals exhibited significantly increased rates of erythrocytosis, with 7-fold higher rates than cisgender males and 83-fold higher rates than cisgender females.
- Transfeminine individuals had elevated anemia rates, particularly compared to cisgender males.
Conclusions:
- Hematologic parameters in transgender individuals on HT should be assessed based on their affirmed gender.
- Further research is needed to understand the clinical implications of testosterone-induced erythrocytosis and feminizing HT-associated anemia.
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