A multicenter cohort of transgender and gender diverse people with multiple sclerosis

A better understanding of MS outcomes in transgender and gender-diverse (TGD) people with MS (PwMS), including those undergoing gender-affirming hormone therapy (GAHT), would improve the clinical care of this underrepresented population and deepen understanding of how exogenous sex hormones may impact MS.

To characterize a cohort of TGD PwMS, describe changes in MS disease activity and outcomes following GAHT, and identify potential gaps in clinical management or social drivers of health (SDoH) in this population.

A multicenter retrospective review was performed on TGD PwMS medical record data to record their relevant demographic, gender identity, and clinical information.

Twenty-two TGD PwMS were identified, 21 were assigned female at birth (AFAB). They had a wide range of gender identities and reproductive histories. Overall, MS disability was mild: median EDSS score was 1.5 and no individuals required ambulatory assistance. Testosterone as GAHT was not associated with clinical relapses, disability progression, Timed 25-Foot Walk slowing, or new radiologic disease activity.

The current findings, that a well-educated, well-insured TGD PwMS cohort (primarily AFAB) on high-efficacy disease-modifying therapy (DMT) had overall mild disease, provides reassurance for TGD about their MS disease trajectory and did not detect any concerns regarding exogenous testosterone.