Challenges of caring for transgender and gender diverse patients with rheumatic disease: presentation of seven patients and review of the literature

Mathias, Kristen; Mathias, Lauren; Amarnani, Abhimanyu; Samko, Tracey; Lahita, Robert G.; Panush, Richard S.

doi:10.1097/bor.0000000000000894

Cited by 7 publications

(7 citation statements)

References 46 publications

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“…Pakpoor et al [171] also reported elevated risk to developing multiple sclerosis in male-to-female transitioning. While the above indicate there is likely some risk in transitioning with hormonal treatment, there is also the issue of clinical care for those with rheumatic diseases who transition [172].…”

Section: Consequences Of Homosexuality and Gender Dysphoria On Health...mentioning

confidence: 99%

Sex Determination in Homo sapiens as a Multi-Step Process: Potential for Development of Variants and Sex Differences in Disease Risk

A. Hart

2024

JBiSE

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Reproduction via cis-binary mechanisms appears to have evolved fairly early in the evolution of complex organisms, and a system committed to prior to evolution of humans. While the evolution of a chromosomal-specific approach has been a successful strategy for survival of a large variety of species including humans, the fidelity of sex determination leading to 100% cis-binary outcomes is not achieved in many species, with evidence for homosexual or bisexual behaviour evident in more than 1500 species. Thus, such outcomes indicates that sex determination is a multi-step process and not a single event, and as such, could lead to the appearance of variants during the process which developed much earlier than humans. Variants could arise either due to intrinsic variation in the steps of determination, or also be influenced by environmental factors of a biological or psychological nature. In contrast to homosexual variants which do not require interventions such as hormone therapy or surgery, expression of gender dysphoria, is more based in psychology, but also has biological underpinnings and can be influenced by such hormonal interventions and surgery. While the numbers of those with gender dysphoria is small (~0.6% -1.0% of population), the attention given to this issue raises the possibility of biological and psychological environmental factors impacting the emergence of some of those expressing gender dysphoria. Furthermore, transitioning from male-to-female or female-to-male can have consequences regarding disease risks latter in life, including the appearance of autoimmune diseases. This review will attempt to review some of the evidence regarding sex determination, discuss why the system has potentially not been improved upon during evolution, how a potential role for sex chromosome function on neurodevelopment may be central to variation in humans,

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Section: Consequences Of Homosexuality and Gender Dysphoria On Health...mentioning

confidence: 99%

Sex Determination in Homo sapiens as a Multi-Step Process: Potential for Development of Variants and Sex Differences in Disease Risk

A. Hart

2024

JBiSE

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“…The existence of a direct causation between the initiation of GAHT and the development or worsening of arthritis should be taken with caution due to the study’s limitations, mainly related to multiple confounders and probable publication bias. Higher-powered prospective studies are needed, and a registry would be valuable [ 80 ].…”

Section: Intersections Of Gendermentioning

confidence: 99%

Tailoring Rheumatoid Arthritis Treatment through a Sex and Gender Lens

Carmona,

Aurrecoechea,

García de Yébenes

2023

JCM

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Rheumatoid arthritis (RA) occurs more frequently in women than in men, and the studies that have addressed clinical and prognostic differences between the sexes are scarce and have contradictory results and methodological problems. The present work aims to evaluate sex- and gender-related differences in the clinical expression and prognosis of RA as well as on the impact on psychosocial variables, coping behavior, and healthcare use and access. By identifying between sex differences and gender-related outcomes in RA, it may be possible to design tailored therapeutic strategies that consider the differences and unmet needs. Being that sex, together with age, is the most relevant biomarker and health determinant, a so-called personalized medicine approach to RA must include clear guidance on what to do in case of differences.

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“…27 A recent systematic literature review highlighted the lack of relevant clinical evidence and stressed the need for gender-diverse recruitment of participants in clinical trials to fill in the gaps in our knowledge. 28 Further research needs to be conducted to understand the experiences of such patients in rheumatology clinics.…”

Section: Disparities By Social Roles and Factorsmentioning

confidence: 99%

Health Equity in Rheumatology: A Global Health Perspective

Sandhu¹,

Wright²,

Fajardo³

et al. 2023

Rheumatology

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The United Nations Sustainable Development Goals emphasize the importance of ensuring the health and wellbeing of all human beings as a necessary precondition for peace and prosperity in the world. The spread of egalitarian values in the modern era has generated discussions about health disparities, with renewed calls to lessen health inequities for vulnerable and marginalized populations. This article briefly discusses health disparities and inequities in medicine, focusing on rheumatology. It is well documented that rheumatic disorders present differently among patients of different sex, gender, race and ethnicity. Despite this, most educational materials and guidelines in rheumatology use images and treatment regimens best suited for Caucasian patients. These differences are amplified by the limited recruitment of diverse patients in clinical trials, resulting in disease stereotypes that are based primarily on Caucasian patients, and do not represent disease manifestations across patient populations. These disparities create significant health inequities when combined with socioeconomic differences, and are further enhanced by implicit and explicit biases faced by patients from minoritized and marginalized communities when seeking healthcare services. Ultimately, this results in worse health outcomes for minority patients, further driving healthcare disparities and inequities across patient populations.There is an urgent need to address these disparities through multiple strategies including the diversification of the healthcare workforce, the introduction of implicit bias training for clinicians, and the creation of educational materials which accurately portray disease manifestations among patients of all races, genders and ethnicities.

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Challenges of caring for transgender and gender diverse patients with rheumatic disease: presentation of seven patients and review of the literature

Cited by 7 publications

References 46 publications

Sex Determination in Homo sapiens as a Multi-Step Process: Potential for Development of Variants and Sex Differences in Disease Risk

Sex Determination in Homo sapiens as a Multi-Step Process: Potential for Development of Variants and Sex Differences in Disease Risk

Tailoring Rheumatoid Arthritis Treatment through a Sex and Gender Lens

Health Equity in Rheumatology: A Global Health Perspective

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