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History of anxiety, depression, and post-traumatic stress disorder diagnoses among midlife and older transfeminine and transmasculine adults in the United States: A cross-sectional analysis within the STRONG cohort.

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Public Health.

Ethan C Cicero1, Jason D Flatt2, Vin Tangpricha1

  • 1Emory University, Atlanta, GA, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 23, 2025
PubMed
Summary
This summary is machine-generated.

Transfeminine adults show a higher prevalence of Alzheimer's disease and related dementias (ADRD) compared to cisgender men and women. This increased risk is not linked to gender-affirming hormone therapy (GAHT).

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Area of Science:

  • Neuroscience
  • Gerontology
  • Public Health

Background:

  • Limited understanding of Alzheimer's disease and related dementias (ADRD) prevalence in transgender populations.
  • Uncertainty regarding increased ADRD risk among transfeminine (TF) adults, particularly those using gender-affirming hormone therapy (GAHT).

Purpose of the Study:

  • To investigate the prevalence of ADRD in transfeminine (TF) adults compared to cisgender men (CM) and cisgender women (CW).
  • To determine if gender-affirming hormone therapy (GAHT) influences ADRD risk in TF adults.

Main Methods:

  • Utilized electronic health records (2006-2023) for 2,362 TF adults (aged 45+) matched with 10 CM and 10 CW per individual.
  • Calculated odds ratios (OR) and 95% confidence intervals (CI) to compare ADRD prevalence.
  • Conducted subgroup analyses for TF individuals using GAHT and TF individuals of color.

Main Results:

  • TF adults exhibited a higher ADRD prevalence (1.8%) compared to CM (0.8%) and CW (0.9%).
  • TF adults had approximately double the odds of ADRD compared to CM (OR=2.3) and CW (OR=1.9).
  • GAHT use did not significantly alter the observed association between TF status and ADRD.

Conclusions:

  • Transfeminine adults have a significantly higher prevalence of ADRD than comparable cisgender individuals.
  • The increased ADRD risk in TF adults is not attributable to gender-affirming hormone therapy (GAHT).
  • Future research should explore modifiable risk factors (e.g., social isolation, hypertension, obesity) using a life-course approach.