Iwamoto, Sean J., et al. "Health considerations for transgender women and remaining unknowns: a narrative review." Therapeutic advances in endocrinology and metabolism 10 (2019): 2042018819871166.
Abstract
Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW’s health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address.
Introduction
In 2016, several groups published priorities for transgender (trans) health and research with a focus on collaboration and overcoming health disparities among this population.1,2 Despite the increasing presence of gender diversity in both mainstream media and medical literature, many barriers to optimal health among trans people still exist. For example, the Report of the 2015 United States (US) Transgender Survey3 showed that healthcare coverage for trans people in the US remains precarious, with 25% of those who sought coverage for hormones in 2014 being denied and 23% of respondents not seeing a doctor out of fear of mistreatment as a trans person. Similarly, in Europe, a 2012 European Union Agency for Fundamental Rights survey found that 22% of trans respondents felt personally discriminated against by healthcare personnel because of their trans identity.4 Many providers, including specialists, do not feel adequately trained to care for trans patients,5–7 which may result in patients seeking alternatives to the standard transition-related options that are described in international guidelines.
Trans people can experience social, hormonal or surgical transition depending on their level of self-acceptance and availability of support and resources. Gender-affirming hormone therapy (GAHT) is often an important aspect of transition-related care, improving quality of life (QOL) and mental health of trans people.8–17 GAHT should be accessible to, but not required of, all trans people. In this narrative review, we aim to provide readers with a comprehensive summary of health considerations related to TW, defined here as people assigned male at birth (AMAB) but who have female gender identity or expression. We also aim to identify areas to focus our research in order to answer the many questions that remain surrounding TW’s health.
We acknowledge that trans terminology is evolving. Though used with the best inclusive intention, terms and phrases to describe trans study populations may still be limited in definition. For example, some may use the phrase, ‘trans people AMAB’, to be inclusive of TW and gender nonbinary people, individuals who do not identify as strictly male or female. For the sake of consistency throughout this narrative review, we will use the abbreviation ‘TW’ to refer to a ‘trans woman’ or ‘trans women’. Table 1 contains additional terminology that will be used. Read more via PMC