The pros and cons of hormone therapy for aging transgender women

An estimated 71% of transgender women use or intend to use gender-affirming hormone therapy (GAHT). Although sample sizes are comparatively small, there are studies that demonstrate psychological advantages of GAHT, whereas others suggest added health risks. A presentation at The North American Menopause Society (NAMS) Annual Meeting in Atlanta, October 12-15, will address the differentiated pros and cons of hormones for transgender women.

Understanding the risks and benefits of GAHT for women in midlife and beyond is important because it’s estimated that nearly one-quarter (23%) of transgender women begin hormone therapy after the age of 40, with 12% beginning GAHT after age 50. Specific areas of focus include mental, cardiovascular, and breast health.

Multiple studies have confirmed improved mental health benefits and a feeling of overall well-being in transgender women using GAHT. Data collected from the National Transgender Discrimination Study examined qualify-of-life outcomes in transgender women aged older than 60 years and found that those who recently initiated GAHT reported statistically higher quality-of-life scores than their age-matched peers who had not initiated GAHT.

Currently, there is no evidence to support the termination of GAHT in transgender women on the basis of age alone, although in most aging populations, there is concern about increased cardiovascular risk. In transgender women using GAHT who have cardiovascular risk factors, literature supports transdermal estradiol as the preferred route.

Multivariable analyses demonstrate that transgender women experience myocardial infarction at approximately two times higher rates than cisgender women, and similar trends have been seen with ischemic stroke. Studies evaluating the risk of breast cancer in transgender women using GAHT have produced mixed results, largely because of limited sample sizes.

Dr. Sarah Pickle from the University of Cincinnati College of Medicine will present this information during the NAMS Annual Meeting and will discuss current GAHT recommendations and additional treatment considerations for transgender patients.

“For most transgender women and transfeminine persons, the well-documented benefits of gender-affirming hormone therapy largely outweigh potential risks. It is important for health care professionals to understand how to counsel patients and mitigate possible risks of hormone therapy while recognizing that transgender patients are more likely to have deleterious health effects from discrimination, marginalization, and lack of access to health care than they are from side effects of hormone therapy,” says Dr. Pickle.

“This study is extremely valuable for health care professionals who are looking for guidance on how to best care for their transgender patients. Among other things, it confirms that more research specific to transgender populations is needed so that health care professionals can make treatment recommendations with greater confidence,” says Dr. Faubion, NAMS medical director.