Approach to the patient: cases of hormonal management in older transgender and gender diverse adults

As the general population continues to shift to an older demographic, more transgender and gender diverse (TGD) adults will seek out endocrinologists and other healthcare providers to help them navigate both initiation and continuation of gender-affirming hormone therapy concurrent with the potential development of age-associated diseases. The purpose of this Approach to the Patient article is a case-based approach to management considerations in older TGD adults in the settings of neurocognitive disorder, increased cardiovascular disease risk, prostate cancer, bone health, and menopause. While evidence-based guidelines for these aging-related conditions do not exist specifically for TGD adults, clinical practice and data from studies in TGD and cisgender adults are discussed to support the approaches to these patient cases. Future research in these areas can inform best practices and clinical guidelines for care of older TGD adults.