Approach to the Patient: Hormonal Therapy in Transgender Adults With Complex Medical Histories

Area of Science:

• Endocrinology
• Gender-affirming care
• Hormone therapy

Background:

• Gender-affirming hormone therapy (GAHT) is increasingly initiated by endocrinologists for transgender and gender diverse (TGD) individuals.
• TGD patients often present with complex medical histories that require careful consideration during GAHT management.
• Shared decision-making between patients and providers is crucial for safe and effective GAHT.

Purpose of the Study:

• To outline management strategies for TGD adults with specific complex medical conditions undergoing GAHT.
• To provide guidance for endocrinologists encountering patients with thromboembolic disease or low bone mineral density during GAHT.

Main Methods:

• This article presents an Approach to the Patient, focusing on clinical considerations.
• Case examples of 2 adults with thromboembolic disease and 2 adults with low bone mineral density are discussed.
• Management considerations for both feminizing and masculinizing GAHT are explored.

Main Results:

• The study highlights the importance of individualized GAHT management based on patient comorbidities.
• Specific challenges and recommendations for managing thromboembolic disease in the context of GAHT are presented.
• Strategies for addressing low bone mineral density in TGD patients receiving GAHT are discussed.

Conclusions:

• Endocrinologists must integrate patient-specific medical histories into GAHT decision-making.
• Careful monitoring and management are essential for TGD patients with thromboembolic disease or low bone density on GAHT.
• Personalized approaches ensure the safety and efficacy of gender-affirming hormone therapy.