Endocrine issues in critically ill transgender patients: A narrative review

Transgender individuals often undergo gender-affirming hormonal therapy (GAHT) to align their physical characteristics with their gender identity, which introduces unique challenges in the management of critically ill patients. In the setting of critical illness, the interactions between GAHT and the body's endocrine response are complex. GAHT can influence the hypothalamic-pituitary-adrenal axis, sex hormone levels, and metabolic parameters, potentially complicating the clinical picture. For example, estrogen therapy in transgender women increases the risk of venous thromboembolism, which is further exacerbated by the immobility and hypercoagulable state often present in critically ill patients. Testosterone therapy in transgender men can lead to erythrocytosis, increasing the risk of thromboembolic events during critical illness. The potential for drug interactions, particularly with medications used in the intensive care unit, also requires careful consideration. Monitoring hormone levels and adjusting GAHT in the acute setting are crucial, although evidence-based guidelines are lacking. The need for individualized care and vigilant monitoring of endocrine and metabolic parameters is paramount to improve outcomes in this vulnerable population.