Endocrine issues in critically ill transgender patients: A narrative review

Area of Science:

• Critical care medicine
• Endocrinology
• Transgender health

Background:

• Gender-affirming hormonal therapy (GAHT) is crucial for transgender individuals.
• Critical illness complicates the management of patients on GAHT.
• GAHT affects endocrine axes and metabolic parameters.

Purpose of the Study:

• To explore the complexities of managing critically ill transgender patients undergoing GAHT.
• To highlight potential complications arising from GAHT interactions in critical illness.
• To emphasize the need for individualized care and monitoring.

Main Methods:

• Review of existing literature on GAHT and critical illness.
• Analysis of endocrine and metabolic changes associated with GAHT.
• Identification of risks such as thromboembolism and drug interactions.

Main Results:

• Estrogen therapy increases venous thromboembolism risk in transgender women.
• Testosterone therapy can cause erythrocytosis, raising thromboembolic risk in transgender men.
• GAHT can alter hypothalamic-pituitary-adrenal axis function and hormone levels.

Conclusions:

• Managing critically ill transgender patients on GAHT requires careful consideration of hormonal effects and drug interactions.
• Individualized treatment plans and vigilant monitoring of endocrine and metabolic parameters are paramount.
• Lack of evidence-based guidelines necessitates a cautious, patient-specific approach.