Menopausal symptoms affect a significant portion of women. Traditional treatment with manufactured hormone therapy can alleviate these symptoms, but many women and their health care providers are concerned about the risks, such as venous thromboembolism and certain types of cancer, demonstrated with manufactured hormone therapy. Compounded bioidentical hormone therapy has been proposed and is often used as a solution for these concerns. Despite this use, no data are currently available to support the claims that compounded bioidentical hormone therapy is a safer or more efficacious option compared with manufactured hormone therapy. A common misperception is that all manufactured products consist of synthetic hormones and all compounded medications consist of natural hormones; however, in fact, significant overlap exists. Several key stakeholder organizations have issued statements expressing concern about the lack of evidence regarding the efficacy and safety of compounded bioidentical hormone therapy, in addition to concerns regarding prescribing patterns. The Women's Health Practice and Research Network of the American College of Clinical Pharmacy recommends against the consistent use of compounded bioidentical hormones as a safer option compared with manufactured therapy and supports the statements of other key organizations, acknowledging the need for more robust clinical studies to evaluate the potential advantages and disadvantages of compounded bioidentical products compared with manufactured products.

No abstract

No abstract

The Department of Veterans Affairs has a policy of welcoming LGBTQ Veterans, and has established working groups to coordinate care for Veterans in this population. We wished to evaluate the care provided to gender-dysphoric Veterans in VANCHCS. Using ICD-10 criteria, we identified a population of 148 Veterans as of May 31, 2018. We stratified these individuals by preferred gender, regardless of “official” records, and further evaluated their medical records for cross-sex hormone therapy and access to mental health, endocrine, speech pathology, and dermatology resources. Of the 148 Veterans, 10 were non-binary, 43 were transmen, and 95 were transwomen. Because of small numbers, we excluded non-binary Veterans from further analysis. The transmen were significantly younger than transwomen (42±13.7 vs. 51.5±15.9 yrs., p< 0.001 by t-test). Transwomen were more likely to be Air Force Veterans than transmen (21.1% vs. 17.1%), and less likely to be Army Veterans (38.9% vs. 43.9%). Transwomen were more likely to see an Endocrinologist (83.2% vs. 72.1%), and Speech Therapy (44.2% vs. 25.6%) than transmen. Cross-sex hormone therapy for transwomen included multiple combinations including gonadotropin-releasing hormone analogs, spironolactone, finasteride, estradiol, and progesterone, whereas for transmen, testosterone was the sole therapy. The majority of our Veterans (65 transwomen (68.4%) and 38 transmen (88.4%) had not undergone gender-affirming surgery Only 59 transwomen (62%) had measurements of prostate-specific antigen (PSA). Both groups were followed comparably in Mental Health Clinics (87.4% for transwomen, 90.7% for transmen). Only 35 transwomen (36.8%) were seen in Dermatology clinics for gender identity issues. In summary, our populations represented diverse backgrounds and received a variety of treatments. We conclude that care for these Veterans could be enhanced by a more consistent, team-based approach to therapy.

No abstract