Gender-affirming interventions and prognosis in multiple sclerosis.

Area of Science:

• Neurology
• Endocrinology
• Immunology

Background:

• Gender-affirming hormone therapy (GAHT) is associated with potential increases in multiple sclerosis (MS) risk.
• The MS disease course in transgender and gender-diverse (TGD) individuals is not well understood.
• This study investigates the MS disease course in TGD individuals diagnosed with MS (TGD-MS).

Purpose of the Study:

• To evaluate the disease course of multiple sclerosis (MS) in transgender and gender-diverse individuals (TGD-MS).
• To compare MS outcomes between transgender women with MS (TW-MS) and transgender men with MS (TM-MS) undergoing GAHT.

Main Methods:

• Retrospective analysis of 17 TGD-MS cases.
• Focus on 10 TGD-MS patients on GAHT, including 5 TW-MS and 5 TM-MS.
• Assessment of symptomatic/asymptomatic disease activity and progressive MS (PMS) onset.

Main Results:

• Transgender women with MS (TW-MS) were older and had later MS onset than transgender men with MS (TM-MS).
• Four TW-MS developed progressive MS (PMS), with GAHT preceding PMS onset in three.
• Higher disability was observed in TW-MS compared to TM-MS.

Conclusions:

• GAHT may modify MS disease course, potentially differing between TW-MS and TM-MS.
• Urgent need for larger, long-term studies to address MS care disparities in TGD populations.
• Comprehensive GAHT history, timely management, and close follow-up are crucial for TGD-MS.