Transgender patients and gender-affirming hormone therapy through the mid-life.

The transgender population, including those assigned female at birth (AFAB) and those assigned male at birth (AMAB), has been understudied in terms of experiences through the menopause transition and midlife.

• No formal recommendation or guidance exists on continuation of gender-affirming hormone therapy (GAHT) through midlife.
• While gender-affirming therapies are supported by organizational guidelines including WPATH Standards of Care 8 (SOC8) and Endocrine Society (2017), evidence on continuation and dose adjustments into mid-life are lacking.
• The menopause transition marks a time of dynamic physiological and hormonal change relevant to both cisgender women and transgender patients.

Data from large cohort studies and small cross-sectional studies suggest increased risk of venous thromboembolism (VTE), stroke, and myocardial infarction in transgender patients assigned male at birth (AMAB) on GAHT.

• Evidence comes from 'a few large cohort studies and small cross-sectional studies.'
• Increased risks identified include venous thromboembolism (VTE), stroke, and myocardial infarction specifically in AMAB individuals on GAHT.
• No specific risk quantification or hazard ratios are provided in the abstract.

For transgender patients assigned female at birth (AFAB) on testosterone therapy, risks of cardiovascular disease, stroke, and effects on bone health are not well defined.

• Inconsistent findings from large cohort studies contribute to the lack of clarity regarding cardiovascular and bone health risks in AFAB individuals on testosterone therapy.
• Both cardiovascular disease risk and stroke risk remain poorly characterized in this population.
• Bone health risks associated with testosterone therapy in AFAB individuals are also not well defined.

The decision to continue GAHT for transgender patients through midlife is currently guided by patient preference along with clinician guidance, in the absence of formal evidence-based recommendations.

• No formal recommendation or guidance on continuation of GAHT through midlife currently exists.
• Further research is described as 'warranted regarding risks of continuing GAHT into mid-life for both AMAB and AFAB patients.'
• The authors note that given the 'significant benefit of GAHT in this population,' future data would be most helpful for counseling on risks and for guiding appropriate monitoring and prevention of related morbidities.