Chronic liver disease and hepatology care in transgender and gender diverse populations.

Transgender and gender diverse people experience disproportionate exposure to risk factors for chronic liver diseases compared to cisgender populations.

• Risk factors that disproportionately affect trans people include viral hepatitis, alcohol use disorder, and metabolic dysfunction.
• These disparities are linked to unique minority stressors related to gender identity, along with additional psychosocial and systemic stressors.
• The review frames these disparities as contributing to broader health disparities in trans communities.

Historical concerns about hepatic effects of gender-affirming hormone therapy (GAHT) were predominantly based on data extrapolated from cisgender populations or hormone formulations no longer in use.

• Prior safety concerns were not derived from studies of trans populations using modern hormone formulations.
• The review notes that older hormone formulations that raised hepatic concerns are no longer recommended for use.
• This data extrapolation from cisgender populations represents a significant methodological limitation in the historical literature.

Modern GAHT is generally safe from a hepatology perspective when used according to guidelines.

• This conclusion is based on the latest available data reviewed by the authors.
• The safety assessment applies specifically to modern formulations used according to current clinical guidelines.
• The authors acknowledge that important knowledge gaps remain despite this general safety finding.

The review identifies significant knowledge gaps in understanding chronic liver disease in transgender and gender diverse populations.

• Knowledge gaps exist in both clinical and research domains related to hepatology care for trans people.
• The review calls for individual, institutional, and systemic changes to address these gaps.
• The authors emphasize the need for culturally appropriate, evidence-based, and affirming care for transgender and gender diverse communities.

The review calls for changes across multiple levels to improve hepatology care for transgender and gender diverse communities.

• Changes are called for at individual, institutional, and systemic levels.
• Both clinical and research domains are identified as requiring reform.
• The goal articulated is to ensure 'culturally appropriate, evidence-based, and affirming care' for trans communities.