Patient-reported outcomes, provider-reported outcomes, and physiologic parameters after gender-affirming hormone treatment in Canada: a systematic review.

A total of 34 articles representing 3990 patients met inclusion criteria from an initial pool of 3315 identified articles across five databases.

• Five databases were searched: MEDLINE, Embase, PsycINFO, Scopus, and CINAHL on December 26, 2023.
• Inclusion criteria required original articles including patients identifying as transgender or gender diverse (TGD) receiving gender-affirming hormonal care in Canada.
• 3315 articles were identified in total, with 34 articles ultimately included.
• The 34 included studies represented 3990 patients.

Physiologic parameters were the most commonly reported outcomes, appearing in 62% of included studies, while patient-reported outcomes appeared in 50% of studies.

• Physiologic parameters were reported in 62% of studies.
• Patient-reported outcomes (PROs) were reported in 50% of studies.
• Only 32% of studies utilized standardized patient-reported outcome measures (PROMs).
• The review highlights a gap in standardized, consistent outcome measurement tools particularly PROMs.

Testosterone treatments showed 80% effectiveness in achieving desired physical changes in studies reporting quantitative results.

• In studies reporting quantitative results, testosterone treatments showed 80% effectiveness in achieving desired physical changes.
• The narrative synthesis revealed positive outcomes and limited adverse effects of gender-affirming hormone therapy overall.
• Results were organized by different treatment types in the narrative synthesis.

Estrogen and antiandrogen treatments improved mental health in 85% of patients in studies reporting quantitative results.

• Several studies demonstrated that estrogen and antiandrogen treatments improved mental health in 85% of patients.
• The narrative synthesis of results revealed positive outcomes and limited adverse effects of gender-affirming hormone therapy.
• Mental health was among the outcomes assessed as part of both provider-reported and patient-reported outcomes.

Canada has experienced a ten-fold increase in referrals for gender-affirming care, yet research on outcomes of Canadian gender-affirming hormonal treatments is lacking.

• A ten-fold increase in referrals for gender-affirming care has been experienced in Canada.
• Clinical guidelines emphasize the importance of a comprehensive and systematic approach to outcome measurement for gender-affirming hormonal care.
• Research is described as lacking on the investigation of outcomes of Canadian gender-affirming hormonal treatments.
• This gap motivated the systematic review.

The review identifies a need for standardized outcome reporting and measurement of the patient's perspective through PROMs in gender-affirming hormone therapy.

• The narrative synthesis underscores the need for standardized, consistent outcome measurement tools, particularly PROMs.
• Only 32% of included studies utilized standardized PROMs.
• The authors state that resolving these issues 'can improve evidence-based practices and support high-quality, patient-centered gender-affirming hormone care.'
• The Critical Appraisal Skills Programme (CASP) and Joanna Briggs Institute (JBI) tools were used to assess methodological quality of included studies.