Hormonal therapy and sex reassignment: a systematic review and meta‐analysis of quality of life and psychosocial outcomes

Murad, Mohammad Hassan; Elamin, Mohamed B.; Garcia, M.; Mullan, Rebecca J.; Murad, Ayman; Erwin, Patricia J.; Montori, Víctor M.

doi:10.1111/j.1365-2265.2009.03625.x

Cited by 501 publications

(335 citation statements)

References 30 publications

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“…Gender affirming care includes the correct use of pronouns and provision of hormone therapy, among others, and may be offered even in settings without referral centres specialized in transgender healthcare. Such services have been shown to reduce mental health risks [22,23] and improve quality of life for transgender people [24]. In the absence of the ability of the public health system to end systemic discrimination towards transwomen, offering hormones and providing an environment where transwomen’s gender identity is respected may be one way to improve linkage to care and increase HIV viral suppression among transwomen.…”

Section: Discussionmentioning

confidence: 99%

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Jalil

Wilson

Luz

et al. 2017

Journal of the International AIDS Society

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Introduction: Evidence suggests that, of all affected populations, transgender women (transwomen) may have the heaviest HIV burden worldwide. Little is known about HIV linkage and care outcomes for transwomen. We aimed to estimate population-level indicators of the HIV cascade of care continuum, and to evaluate factors associated with viral suppression among transwomen in Rio de Janeiro, Brazil. Methods: We conducted a respondent-driven sampling (RDS) study of transwomen from August 2015 to January 2016 in Rio de Janeiro, Brazil and collected data on linkage and access to care, antiretroviral treatment and performed HIV viral load testing. We derived population-based estimates of cascade indicators using sampling weights and conducted RDS-weighted logistic regression analyses to evaluate correlates of viral suppression (viral load ≤50 copies/mL). Results: Of the 345 transwomen included in the study, 89.2% (95% CI 55–100%) had been previously tested for HIV, 77.5% (95% CI 48.7–100%) had been previously diagnosed with HIV, 67.2% (95% CI 39.2–95.2) reported linkage to care, 62.2% (95% CI 35.4–88.9) were currently on ART and 35.4% (95% CI 9.5–61.4%) had an undetectable viral load. The final adjusted RDS-weighted logistic regression model for viral suppression indicated that those who self-identified as black (adjusted odds ratio [aOR] 0.06, 95% CI 0.01–0.53, p < 0.01), reported earning ≤U$160/month (aOR 0.11, 95% CI 0.16–0.87, p = 0.04) or reported unstable housing (aOR 0.08, 95% CI 0.01–0.43, p < 0.01) had significantly lower odds of viral suppression. Conclusions: Our cascade indicators for transwomen showed modest ART use and low viral suppression rates. Multi-level efforts including gender affirming care provision are urgently needed to decrease disparities in HIV clinical outcomes among transwomen and reduce secondary HIV transmission to their partners.

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Section: Discussionmentioning

confidence: 99%

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Jalil

Wilson

Luz

et al. 2017

Journal of the International AIDS Society

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“…Similar to others (5, 7), we found that the prevalence of suicide in trans persons (902/100 000 persons) was higher than that in the general Belgian female (12.8/100 000 persons) and male (34.9/ 100 000 persons) populations within the same age category, especially in trans women (31). Even though cross-sex reassignment therapy has been reported to be associated with better functioning in terms of gender dysphoria relief, QoL improvement, psychological functioning, and decrease in suicide attempts (32,33,34,35,36), the relatively high suicide rate during and after transition shows the fragile psychological position of some trans persons.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study

Wierckx¹,

Elaut

Declercq

et al. 2013

European Journal of Endocrinology

283

216

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Objective: This study evaluated the short-and long-term cardiovascular-and cancer-related morbidities during cross-sex hormone therapy in a large sample of trans persons. Subjects and methods: A specialist center cross-sectional study compared 214 trans women (male-to-female transsexual persons) and 138 trans men (female-to-male trans persons) with an age-and gender-matched control population (1-3 matching). The participants were on cross-sex hormone therapy for an average of 7.4 years. We assessed physical health and possible treatmentrelated adverse events using questionnaires. Results: Five percent of trans women experienced venous thrombosis and/or pulmonary embolism during hormone therapy. Five of these adverse events occurred during the first year of treatment, while another three occurred during sex reassignment surgery. Trans women experienced more myocardial infarctions than the control women (PZ0.001), but a similar proportion compared with control men. The prevalence of cerebrovascular disease (CVD) was higher in trans women than in the control men (PZ0.03). The rates of myocardial infarction and CVD in trans men were similar to the control male and female subjects. The prevalence of type 2 diabetes was higher in both trans men and women than in their respective controls, whereas the rates of cancer were similar compared with the control men and women. Conclusion: Morbidity rate during cross-sex hormone therapy was relatively low, especially in trans men. We observed a higher prevalence of venous thrombosis, myocardial infarction, CVD, and type 2 diabetes in trans women than in the control population. Morbidity rates in trans men and controls were similar, with the exception of the increased prevalence of type 2 diabetes.

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“…Psychological evaluation has shown that sex reassignment increases the well-being of transsexual subjects (1)(2)(3). Cross-sex hormone treatment has an important role in acquiring the secondary sex characteristics of the desired sex (4).…”

Section: Introductionmentioning

confidence: 99%

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

Asscheman

Giltay²,

Megens³

et al. 2011

European Journal of Endocrinology

474

379

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Objective: Adverse effects of long-term cross-sex hormone administration to transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones. Design: A cohort study with a median follow-up of 18.5 years at a university gender clinic. Methods: Mortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses. Results: In the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population. Conclusions: The increased mortality in hormone-treated MtF transsexuals was mainly due to nonhormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death. In the FtM transsexuals, use of testosterone in doses used for hypogonadal men seemed safe.

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Hormonal therapy and sex reassignment: a systematic review and meta‐analysis of quality of life and psychosocial outcomes

Abstract: Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.

Cited by 501 publications

References 30 publications

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

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