Kidney Health and Gender-Affirming Hormone Therapy for Transgender and Gender Diverse Individuals.

Current eGFR equations reliant on sex-specific factors may misrepresent kidney function in transgender and gender diverse individuals.

• eGFR equations use sex-specific factors that may not appropriately apply to TGD individuals undergoing hormone therapy.
• Misrepresentation of kidney function can lead to misdiagnosis or misclassification of kidney disease stages.
• The review identifies this as a significant clinical challenge for TGD populations accessing medical care.

Testosterone therapy and estrogen therapy have differential effects on serum creatinine levels in transgender individuals.

• Testosterone therapy often raises serum creatinine (SCr) levels.
• Estrogen therapy may lower or has no effect on SCr levels.
• These changes reflect hormonal influences on muscle mass and creatinine production rather than changes in actual kidney function.

Gender-affirming hormone therapy alters serum creatinine and cystatin C differently depending on whether masculinizing or feminizing hormones are used.

• Both SCr and cystatin C are biomarkers used in eGFR calculation and are affected by GAHT.
• The differential effects on these biomarkers complicate accurate kidney function assessment in TGD individuals.
• This finding underscores the inadequacy of applying standard eGFR equations without accounting for hormone use.

Estrogen may offer renal protection while testosterone may elevate kidney-related risks.

• GAHT can affect CKD progression and the incidence of AKI due to hormonal effects.
• Estrogen therapy is associated with potential renal protective effects.
• Testosterone therapy may elevate risks related to kidney health.
• The review notes that more data are needed concerning long-term effects of GAHT on CKD and AKI incidence and progression.

Kidney transplant considerations for transgender and gender diverse patients involve multiple complex factors.

• Relevant factors include the effect of hormone therapy on allograft and patient survivals.
• Drug-drug interactions between GAHT and immunosuppressive medications are a concern.
• Unique anatomical challenges must also be considered in the transplant setting.
• The review identifies this as an area of particular complexity for TGD individuals.

The lack of inclusive data in kidney disease registries and national databases for TGD populations limits understanding of GAHT effects on kidney health.

• TGD populations face significant challenges in accessing medical care.
• Current registries and national databases do not adequately capture TGD individuals as a distinct population.
• This data gap limits the ability to assess the full effect of GAHT on kidney health outcomes.
• The review calls for comprehensive and longitudinal research to address these gaps.

GAHT regimens differ by gender identity, with estrogen therapy used for transgender women and transfeminine individuals, testosterone therapy for transgender men and transmasculine individuals, and distinct regimens for nonbinary individuals.

• Estrogen therapy is typically used for transgender women and transfeminine individuals.
• Testosterone therapy is typically used for transgender men and transmasculine individuals.
• Separate therapy regimens exist for individuals who are nonbinary or identify with another gender not culturally assigned to their sex assigned at birth.
• These distinctions are clinically relevant when assessing the kidney health implications of GAHT.