Standards of Care for the Health of Transgender and Gender Diverse People, Version 8
"Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8.
Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment.
Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings."
💬 Standards de soins pour la santé des personnes transgenres et de la diversité de genre, version 8
"Contexte: Les soins de santé pour les personnes transgenres sont un domaine interdisciplinaire qui évolue rapidement. Au cours de la dernière décennie, on a assisté à une augmentation sans précédent du nombre de personnes transgenres et de la diversité de genre (TDG) à la recherche d’un soutien et d’un traitement médical d’affirmation de genre, parallèlement à une augmentation importante de la littérature scientifique dans ce domaine. L’Association mondiale des professionnels pour la santé transgenre (WPATH) est une association professionnelle internationale et multidisciplinaire dont la mission consiste à favoriser les soins fondés sur les preuves, l’éducation, la recherche, les politiques publiques et le respect dans le domaine de la santé transgenre. L’une des principales fonctions de la WPATH est d’établir des Standards de soin (SDS) se basant sur les évidences scientifiques et empiriques répondant aux normes de rigueur les plus élevées. Les SDS ont été initialement élaborés en 1979, et la dernière version (SDS-7) a été publiée en 2012. Au vu de l’augmentation des données probantes, la WPATH a commandé une nouvelle version des Standards de soins, les SDS-8.
Objectif: L’objectif global des SDS-8 est de fournir aux professionnels de la santé travaillant avec les personnes TDG des recommandations cliniques basées sur les preuves. Ceci afin de favoriser chez les personnes TDG un accès à des voies sûres et efficaces dans le but d’atteindre un confort personnel durable avec leur genre, afin d’optimiser leur santé physique globale, leur bien-être psychologique et leur épanouissement personnel.
Méthodologie: Les SDS-8 sont fondés sur les meilleures données scientifiques disponibles et sur un consensus professionnel d’experts dans le domaine de la santé transgenre. Des professionnels et des acteurs internationaux ont été sélectionnés pour siéger au comité des SDS-8. Les recommandations ont été élaborées sur la base de données provenant de revues de littérature systématiques indépendantes, lorsque celles-ci étaient disponibles, d’analyses de fond et d’avis d’experts. Les recommandations ont été graduées en fonction des données probantes disponibles à l’appui des interventions, d’une discussion sur les risques et les torts, ainsi que de la faisabilité et de l’acceptabilité dans différents contextes et pays."
🍁 CPATH: Canadian Professional Association for Transgender Health
"The Canadian Professional Association for Transgender Health (CPATH) is a national multidisciplinary, professional organization, that works to support the health, well being, and dignity of trans and gender diverse people. Among the professionals included in our membership are family physicians, endocrinologists, pediatricians, surgeons, social workers, sexologists, psychologists, psychiatrists, speech therapists, educators, and lawyers, as well as organizational members that provide front line services and support to trans people across Canada. As a national organization, CPATH acknowledges that its work takes place across the traditional lands and territories of Indigenous Peoples presently called Canada."
💬 CPATH: Le Association Canadienne des Professionnels de la Santé Transgenre
💬"Le Association canadienne des professionnels de la santé transgenre (CPATH) est une organisation professionnelle nationale multidisciplinaire qui œuvre pour la santé, le bien-être et la dignité des personnes trans et de diverses identités de genre. Parmi nos membres figurent des médecins de famille, des endocrinologues, des pédiatres, des chirurgiens et des travailleurs sociaux. des sexologues, Des psychologues, des psychiatres, des orthophonistes, des éducateurs et des avocats, ainsi que des membres d’organismes qui offrent des services et du soutien de première ligne aux personnes transgenres partout au Canada. En tant qu’organisme national, CPATH reconnaît que son travail se déroule sur les terres et territoires traditionnels des peuples autochtones qui constituent aujourd’hui le Canada."
TPATH: The Transgender Professional Association for Transgender Health
"The Transgender Professional Association for Transgender Health is the first global transgender healthcare organization headed by trans-identified health care professionals, broadly identified as researchers, clinicians, providers-in-training, activists and other service-oriented experts. We recognize that trans individuals are represented in the full spectrum of transgender health care professions and expertise, as we have been since the field’s inception and seek to represent these professionals and their community within the World Professional Association for Transgender Health, associated regional organizations (e.g., ANZPATH, CPATH, EPATH, USPATH), and the larger sphere of transgender health care. TPATH is an outgrowth of several conversations held by trans professionals and activists at the 2016 WPATH conference in Amsterdam."
The GENDER-Q
"The GENDER-Q is a rigorously designed patient-reported outcome measure that can be used to evaluate outcomes and experience of gender-affirming care. The GENDER-Q measures 13 overarching domains. Each domain includes 2 or more independently functioning scales. Clinicians and researchers are able to administer the subset of scales relevant to their situation."
"The GENDER-Q patient-reported outcome measure was authored by 🍁Drs. Anne Klassen, Andrea Pusic and Manraj Kaur."
🍁🦁 New Brunswick Trans Health Network: LinkTree
"We are an interdisciplinary group of healthcare professionals and community partners seeking to improve services for transgender people in NB."
🍁🦁 2SQTP-NB/P2SQT-NB: Education Package, Version 3
"This education package seeks to share lived experiences with accessing care in New Brunswick, was created by Two-Spirit, trans, Indigiqueer, and gender-diverse (2STIGD) individuals in consultation with other 2STIGD community members, with a goal of incorporating as many intersecting identities and voices as possible. Because the project is action oriented, we seek to share our real and lived experiences with the medical system and society at large, and we offer these resources as a way to make a change. Where we repeat ourselves in the education package, it’s intentional. Our experiences have been overlooked, erased, and misunderstood repeatedly. We want better care for others and for ourselves."
💬 P2SQT-NB/2SQTP-NB: Trousse de sensibilisation, Troisième version
La présente trousse de sensibilisation vise à communiquer des expériences vécues en matière d’accès aux soins au Nouveau-Brunswick. Elle a été créée par des personnes bispirituelles, transgenres, queers autochtones et de la diversité de genre (2STQADG) en consultation avec d’autres membres de la communauté 2STQADG, dans le but de laisser place au plus grand nombre possible d’identités et de voix intersectionnelles. Puisque notre initiative est axée sur l’action, nous cherchons à faire connaître nos expériences réelles et vécues dans le système médical et la société dans son ensemble, et nous offrons ces ressources comme outils pour changer la donne. Dans une trousse de sensibilisation, les répétitions sont intentionnelles. Nos expériences ont été négligées, effacées et mal comprises à maintes reprises. Nous voulons de meilleurs soins pour les autres et pour nous-mêmes.
🍁🥔 Gender Affirming Care PEI
"Gender Affirming Care PEI is a community-based team working to improve health access and equity for transgender, gender-divergent, transsexual, and intersex individuals in Prince Edward Island."
🍁🥔💬 Soins D’affirmation de Genre ÎPÉ
💬 "Soins d’affirmation de genre ÎPÉ est une organisation communautaire qui milite pour l’accès et l’équité en santé pour les insulaires transgenres, transexuels, intersexes et divers dans le genre."
🍁🐕 Trans Support NL: Gender-Affirming Care Toolkit
"An introduction to gender diversity and to ensuring that all care settings are places where everyone feels seen, respected, and safe." "Developed by and for the community, NL Gender-Affirming Care Toolkit was designed to help primary care providers feel equipped, informed, and ready to offer affirming care. It breaks down barriers, fills knowledge gaps, and helps create healthcare spaces where Two-Spirit, trans, non-binary, and gender diverse people can feel safe, respected, and seen."
📑 Direct Link
🍁 Rainbow Health Ontario
"Rainbow Health Ontario helps build a healthcare system that better serves 2SLGBTQ+ people across the province. We train healthcare and service providers to deliver culturally and clinically competent care, create accessible and evidence-based health resources, support policy change, and amplify research in 2SLGBTQ+ health. As a 2SLGBTQ+-led organization grounded in lived experience and clinical knowledge, we work to close gaps in care and improve health outcomes for our communities."
Trans Health Knowledge Base
"This knowledge base answers common questions from trans and non-binary people in Ontario. Designed for residents 18 and over, it uses plain language to clarify social and medical transition processes and help you find community support. Where possible, we’ve included system navigation tips for those facing additional barriers to health care."
Sherbourne’s Guidelines for Gender-affirming Primary Care with Trans and Non-Binary Patients: Fourth Edition 📑 Direct Link
"The fourth edition of Sherbourne’s Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients, like its predecessor, was authored by Dr. Amy Bourns, a family physician on Sherbourne’s 2SLGBTQ+ Health Team. In addition to incorporating recently available evidence in both general primary care and trans health, the 2019 edition features revisions and expansions in several areas"
The Trans Primary Care Guide
"The Trans Primary Care Guide, the online interactive tool based on the Guidelines, has also been updated to reflect the most current clinical information consistent with this new 4th edition of the Guidelines."
🍁💬 Santé arc en ciel Ontario (SAO)
💬"Santé arc en ciel Ontario (SAO), un programme de Sherbourne Health, crée des possibilités afin que le système de santé soit mieux en mesure de servir les communautés 2SLGBTQ. SAO offre de la formation aux prestataires de soins de santé partout en province afin d’accroître leur sentiment de compétence sur les plans clinique et culturel en ce qui a trait à la prestation de soins aux bénéficiaires 2SLGBTQ qui font appel à leurs services. SAO apporte également des changements aux systèmes en créant des ressources imprimées et électroniques fondées sur des données probantes, ce qui offre une perspective de la santé 2SLGBTQ au chapitre des processus de politiques publiques, en jouant un rôle de catalyseur de recherche et en organisant la plus importante conférence en santé 2SLGBTQ au Canada."
🍁 Trans Care BC
"Trans Care BC is a provincial clinical program operated by the Provincial Health Services Authority (PHSA). We work with our partners to set direction and provide leadership for trans health services across B.C. Our work helps ensure trans, Two-Spirit and non-binary people get the care they need when and where they need it."
Education Centre
"Courses and learning tools for clinicians and the community."
🍁 The Trans Wellness Initiative
"The Trans Wellness Initiative aims to improve the health and wellness of trans and nonbinary communities in Alberta by building connections, facilitating access, and fostering capacity. The website is a place for trans folks to get information and resources about health topics that matter to them – whether about gender affirming gear, sexual health, or navigating surgical pathways. It is also a place where healthcare providers can find guidance and education in providing competent care for trans and nonbinary communities."
Primary Care Resource Guide
"The intent behind this webpage is to provide a streamlined run-down of necessary information for transition-related care at point of care. This project is privileged by collaboration between members of the trans community and numerous healthcare providers."
🍁 The Queer + Trans Health Collective
"The Queer & Trans Health Collective (QTHC) is an Edmonton-based, grassroots health organization run by and for queer and trans community members. We empower queer and trans wellbeing by providing and promoting equitable access to health education, support, capacity building, community-based research, and provider training."
Fenway Health
"The Trans Health Program at Fenway Health supports members of trans and gender diverse communities, their families, and the providers who serve them. We provide patient-centered, evidence-based care to ensure trans and gender diverse people are informed and affirmed in their gender and healthcare needs."
LGBTQIA+ Health Education Center - A program of the Fenway Institute
"Our library is open. We’re proud to provide no-cost educational materials on the latest developments, issues, and best practices in providing affirming LGBTQIA+ healthcare, by leading researchers and clinicians from across the country."
TransLine: Transgender Medical Consultation Service
"TransLine is a collaborative project started by Dr. Dawn Harbatkin and Dr. Nick Gorton at Lyon-Martin Health Services in 2011. Due to an increase in demand and utilization of TransLine, in 2013, we expanded our collaboration to include other expert clinicians in the field of trans health outside of Lyon-Martin."
🍁 Community-Based Research Centre: Queering the Compass
"The Queering the Compass project promotes the sexual and reproductive health (SRH) of 2S/LGBTQIA+ communities by advancing the knowledge and skills needed to navigate their SRH care and by improving the capacity, knowledge, and skills of the healthcare/service providers who serve them. Using a collaborative approach, CBRC works alongside six regional delivery partners, 2S/LGBTQIA+ community members across Canada, and healthcare/service providers to develop and deliver a range of initiatives including knowledge exchange resources, community programming, and policy that focus on addressing sexual and reproductive health inequities across Canada. Recognizing the diverse factors that contribute to sexual and reproductive health and well-being for 2S/LGBTQIA+ people, we extend our focus beyond sexually transmitted infections to address topics such as gender-affirming care, pleasure, sex and disability, and family planning."
📑 The Care I Want: An Illustrated Guide to Navigating Healthcare
"2S/LGBTQ+ people have unique needs when it comes to sexual and reproductive health. But, accessing related health services isn’t always easy. Receiving appropriate sexual and reproductive health care can mean coming out, risking stigma or discrimination, or dealing with health service providers who aren’t educated on queer issues. The Care I Want offers tips and advice to get the most out from these health services."
🍁💬 Le Centre de recherche communautaire: Repères Queers
"Le projet Repères Queers vise à promouvoir la santé sexuelle et reproductive des personnes 2S/LGBTQIA+. En faisant progresser la connaissance et en offrant des outils aux membres de nos communautés, ce projet offre du soutien à ces personnes lorsqu’elles naviguent le système de santé, et ce dans le but qu’elles obtiennent les soins dont elles ont besoin. Ce projet vise aussi à développer les capacités, les compétences et les connaissances des professionnel·le·s de la santé et des services sociaux. Le CBRC travaille en collaboration avec six partenaires régionaux, des membres de nos communautés et des prestataires de soin de santé partout au Canada. À travers ces collaborations, nous développons et mettons en place différentes initiatives pancanadiennes incluant des ressources d’échange de connaissances, des programmes communautaires et des politiques qui visent à contrer les inégalités vécues par nos communautés. Compte tenu des différents facteurs qui contribuent à la santé et au mieux-être en matière de sexualité et de reproduction chez les personnes 2S/LGBTQIA+, nous sommes allé·e·s au-delà des infections transmises sexuellement et par le sang pour nous intéresser à des sujets comme les soins relatifs au genre, le plaisir, le sexe et le handicap et la planification familiale."
📑💬 Mes soins comme je les veux: un guide illustré pour tirer le meilleur parti des services de santé
💬 "Les personnes 2S/LGBTQ+ ont des besoins spécifiques en matière de santé sexuelle et reproductive. L’accès aux soins de santé n’est pas toujours facile. Pour recevoir des soins de santé appropriés, ces personnes doivent faire part de leur identité aux professionnel·les de la santé. Cette réalité les expose à des expériences de stigmatisation et de discrimination, ou encore les force à interagir avec des professionnel·les qui ne sont pas éduqué·es au sujet des enjeux de santé qui touchent les personnes queers. Mes soins comme je les veux est un guide qui offre des trucs et des astuces pour naviguer le système de santé et optimiser les chances de recevoir des soins adéquats."
🍁TransCare+
"TransCare+ is an online resource hub that focuses on supporting the health, care and wellness of trans and gender diverse folks."
"It is with deep sadness that we announce the closure of TransCare+. This website will remain live as a resource hub. We hope the tools and knowledge shared here continue to support and strengthen 2SLGBTQ+ communities."
🍁The 2S/LGBTQ+ Health Hub
"The 2S/LGBTQ+ Health Hub is a collaboration between over 50 community leaders, scholars, researchers, and healthcare providers from across Canada, offering training, mentorship, networking, and capacity-building opportunities to emerging leaders in 2S/LGBTQ+ health and research."
🍁Script
"Script is an accessible, one-stop destination for credible LGBTQ2S+ health information. We recognize that queer and trans people are too often dismissed, ignored or condescended to as they navigate healthcare systems that aren't equipped to serve them. Script's mission is to deliver crucial, timely stories about LGBTQ2S+ health that actually reflect readers' perspectives, experiences and unique healthcare needs. We aim to have our coverage capture the complexity of how factors such as race, class, citizenship status and disability affect the ways people move through the world and the impacts this has on health outcomes.
We believe that access to equitable healthcare is a human right. We believe that discussions about our health should be frank, but that there's also room for irreverence and fun. We believe that factual, reliable healthcare information can empower people to improve their own well-being. We are pro-queer, pro-sex and pro-bodily autonomy."
🍁 Women and Gender Equality Canada Partner
🍁💬Script
"Script est une référence accessible et centralisée pour obtenir des informations fiables sur la santé LGBTQ2S+. Nous reconnaissons que les personnes queer et trans sont trop souvent mises à l'écart, ignorées ou méprisées lorsqu'elles doivent faire face à des systèmes de santé qui ne sont pas équipés pour les prendre en charge. La mission de Script est de fournir des informations cruciales et actuelles sur la santé LGBTQ2S+ reflétant réellement les points de vue, les expériences et les besoins spécifiques de nos lecteurices en matière de soins de santé. Nous voulons que notre couverture médiatique reflète la complexité des facteurs-tels que la race, la classe sociale, le statut de citoyenneté et le diversité capacitaire-qui influencent la façon dont les gens vivent dans le monde et les conséquences que cela a sur leur santé.
Nous croyons que l'accès à des soins de santé équitables est un droit humain. Nous croyons que les discussions sur notre santé doivent être franches, mais qu'il y a aussi de la place pour de la dérision et du plaisir. Nous croyons que des informations factuelles et fiables sur les soins de santé peuvent donner aux gens des moyens d'améliorer leur propre bien-être. Nous sommes pro-queer, pro-sexe et pro-autonomie corporelle."
🍁💬Femmes et Égalité des genres Canada Partenaire
Conscious Euphoria: A Practical Guide to Gender-Affirming Healthcare
"A Practical Guide to Gender-Affirming Care is a 145-page illustrated digital guide to transgender healthcare, covering surgeries, hormone therapy, and fertility options in a clear and accessible format. Designed to make complex medical information easier to understand, this ebook explores a wide range of gender-affirming procedures — including top surgery, vaginoplasty, phalloplasty, facial surgeries, and more — alongside hormone treatments and reproductive options. Each section is supported by simple illustrations and straightforward explanations."
Courses and Education
🍁Canadian Healthcare Education Network: Culture and Diversity in a Binary World
"The “Culture and Diversity in a Binary World” program delves into the critical intersections of cultural diversity, neurodiversity, and gender identity in healthcare. This course is designed to equip participants with the tools and knowledge to understand the unique challenges faced by diverse populations. By examining the impacts of systemic bias and social determinants of health, participants will explore how cultural and identity-related factors influence patient experiences and outcomes."
"This program is ideal for:
• Healthcare professionals, including nurses, social workers, and allied health practitioners.
• Patient advocates, navigators, and harm reduction workers.
• Anyone interested in fostering equity and inclusion in healthcare environments."
"3 hrs/day over 4 days online. Fully Online - Live Instructor Led sessions"
🍁Canadian Queer Medical Students Association: 2SLGBTQ+ Education Program
"Welcome to the CQMSA 2SLGBTQ+ Education Program! This program is designed by medical students, for medical students, as a primer for those who wish to expand their knowledge on 2SLGBTQ+ health care. The entire program is completely asynchronous and self-paced. Feel free to work through it all in one sitting, or over the course of an entire year. While it isn’t exhaustive, we hope this serves as a comprehensive jumping-off point for your own learning. Plus, get a shiny certificate with your name when you finish all 4 modules!
Each module contains a set of learning objectives, various resources we recommend for achieving these objectives, an exercise or activity, and a self-quiz of either 10-20 multiple choice questions or a reflection exercise. We’ll also ask for your feedback along the way, as this program is new. Don’t worry, all your responses are anonymous to the CQMSA team."
🍁L’Association canadienne des étudiant·es 2SLGBTQIA+ en médecine: 2SLGBTQ+ Education Program
💬"L’ACÉQM travaille fort pour desservir les étudiant·e·s de partout au Canada dans les deux langues officielles. Nous préparons activement un programme bonifié avec des ressources en français pour mieux former nos participant·e·s francophones. Suivez-nous sur les réseaux sociaux pour rester à l’affût de nos projets!"
Teaching LGBTQIA+ concepts and terms through both didactic material and experiential activities which focus on ensuring that all staff in health centers are trained – including front-line staff, the core clinical team, social workers, case managers, administrative staff, enabling staff, and members of governing boards.
Addressing unique challenges in LGBTQIA+ health, based on cumulative evidence from health disparities research.
Focusing attention on diverse LGBTQIA+ populations and their unique needs, such as communities at the intersections of race, ethnicity, language, geography and age.
Guiding organizations in collecting data on sexual orientation and gender identity (SOGI) and recording it in electronic health records (EHRs).
Collaborating with partner organizations to create and sustain a welcoming and affirming environment for LGBTQIA+ patients, students, and staff.
🍁TransCare+ Online Courses
"Our interactive e-learning hub offers a wide variety of courses pertaining to 2SLGBTQIA+ health, care and wellness."
Center of Excellence For Transgender Health Interactive Course: Acknowledging Gender and Sex
"Objectives:
Demonstrate how to collect the two-step gender and sex differentiation questions, using appropriate language.
Demonstrate the use of appropriate language to explain to all patients why they are being asked separate questions about their gender and sex.
State at least three reasons why the two-step gender and sex method is important.
Describe at least three ways in which cultural competence in transgender care affects health outcomes for this population.
Correctly identify transgender patients and ensure they receive appropriate medical attention."
AIDS United University Let's Talk About Gender
"Transphobia continues to drive health disparities and create barriers to care. For transgender and gender non-conforming people (TGNC), these disparities can negatively impact all aspects of a client's or patient's health, delay or postpone care, and increase medical distrust. The Let's Talk About Gender course is designed for community health workers (CHWs) seeking to increase their knowledge and skills when working with TGNC clients and patients. The tools learned in this series will build trust, understanding, and safety for TGNC clients and patients. The course is provided free of charge." "Yes, a certificate is provided after completing each module. The certificate will be available to download from your student dashboard." "We anticipate that it will take learners approximately 2 hours to complete all four courses."
Building Equity, Serving BIPOC LGBTQ+ Communities Training Series
"Stigma, discrimination and systemic barriers to care drive medical mistrust and thwart our ability to end the HIV epidemic. For members of the BIPOC LGBTQ+ community, experiences of discrimination can result in delayed care, impacting health outcomes and quality of life. The Building Equity, Serving BIPOC LGBTQ+ Communities Training Series will provide people working in health care — from nurses and doctors to pharmacists and physical therapists — with the tools needed to build health equity in their settings. The course is provided free of charge." "Yes, a certificate is provided for completing the series. The certificate will be emailed to you after completion of the final course in the series." "We anticipate that it will take learners approximately three hours to complete all three courses in the training series."
🍁 Rainbow Health Ontario Trans Primary Care: Feminizing Hormone Therapy
"The goal of hormone therapy in transfeminine patients is to reduce the endogenous effects of testosterone such as a coarse body hair and facial hair; and to induce feminine secondary sex characteristics such as breast and hip development, in keeping with the patient’s individual goals. Physiologically, this requires a suppression of endogenous androgens and the addition of estrogen."
🍁🥔 GAC PEI
📑 GAC PEI: Quick Reference Sheet: Feminizing Hormone Therapy
"These guidelines do not present it as a ‘Standard of Care’ but instead as a guide to help clinicians in their day-to-day practice. Adaptations may be considered based on each
patient’s unique circumstances. Clinicians must use their own expertise and decision-making skills within each clinical encounter."
🍁 Trans Care BC Estrogen-based hormones
"Estrogen-based therapies are also known as “feminizing hormones.” To be more inclusive of diverse gender identities, we are using language that focuses on anatomy, treatments and presenting concerns, rather than gender. Estrogen-based therapies include estrogen, testosterone blockers and progesterone." "This page describes the advantages, disadvantages, expected effects and potential risks of these therapies. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you."
FOLX Health What Physical Changes to Expect on Estrogen Hormone Replacement Therapy, Explained by FOLX
"The individual effects of estrogen HRT (alongside anti-androgens like spironolactone or progesterone, if also taken) are going to be different depending on the person. While there are some general changes that you can expect, how fast or to what degree these changes take place will vary from body to body. Generally, lower doses of estrogen correlate to slower or more gradual changes, and higher doses are associated with faster changes. We know that many people’s first question is what changes to their body they can expect to see on estrogen HRT. With that in mind, we’ve mapped out a generalized timeline for the secondary sex characteristics you might see and when."
Estrogen HRT & Breast Growth
"Have you wondered how estrogen HRT changes your body? There isn’t a ton of clinical data looking at the effects of estrogen on breast growth, especially for trans, non-binary, and GNC folks, but in this article we look at what we do know, what size most people will arrive at, and what you can do if all the changes are happening a bit too fast."
Transfeminine Science
"Transfeminine Science is a resource for original informational content on the subject of transfeminine hormone therapy. This form of hormone therapy is also known variously as feminizing hormone therapy (FHT), gender-affirming hormone therapy (GAHT) for transfeminine people, and, more in the past, male-to-female (MtF) hormone replacement therapy (HRT). It involves the use of female sex hormones including estrogens and progestogens, as well as androgen-opposing medications known as antiandrogens, to produce feminization, demasculinization, alleviation of gender dysphoria, and other changes in transgender women and non-binary transfeminine individuals." "The content on this site is written by transgender people, for transgender people, as well as for medical providers and academics in transgender health."
Hormone Replacement Therapy Research
Estradiol Concentrations for Adequate Gender-Affirming Feminizing Therapy: A Systematic Review
📑 Direct Link 🔓 Open Access
"Guidelines recommend serum estradiol concentrations of 100–200 pg/mL for transgender women prescribed oral, subcutaneous, or transdermal estradiol with or without adjunct antiandrogen as gender-affirming feminizing hormone therapy (HT). The purpose of this systematic review was to evaluate if the guideline range of 100–200 pg/mL for estradiol concentration is associated with indicators of adequate gender-affirming feminizing HT, specifically feminizing sufficiency, insufficiency, testosterone suppression, or toxicity in transgender women."
"Existing data do not support a target 100–200 pg/mL serum estradiol concentration range in individuals treated with gender-affirming feminizing HT. Estradiol concentrations can be used as one data point in overall therapy, but monitoring individual goals and patient satisfaction likely provides more clinical value than targeting a potentially arbitrary estradiol therapeutic range. Some patients may achieve goals with estradiol levels below 100 pg/mL, while others may benefit from concentrations >200 pg/mL and/or display transient elevations that do not necessitate dosing adjustments. There were no additional risks of gender-affirming feminizing HT associated with estradiol concentrations outside the 100–200 pg/mL guidance range."
Author: Winston-McPherson GN, Thomas TA, Krasowski MD, et al
Publication: LGBT Health. 2025;12(7):477-489
Date: 24 June 2025
DOI: 10.1089/lgbt.2024.0407
Early body composition changes in trans women on low-dose estradiol: comparing oral vs sublingual administration using dual energy absorptiometry and bioelectrical impedance analysis Journal Link
"Low-dose estradiol induces significant feminizing body composition changes within 6 months of GAHT, with sublingual administration potentially limiting fat accumulation while achieving a feminine body shape."
Author: Iris Yaish, Assaf Buch, Guy Gindis, Yael Sofer, Mira Arbiv, Yaffa Moshe, Yona Grenman, Karen Tordjman
Publication: The Journal of Sexual Medicine, Volume 22, Issue 4, April 2025, Pages 625–635
Date: 22 Feb 2025
DOI: 10.1093/jsxmed/qdaf005
Histologic Findings in Surgical Pathology Specimens From Individuals Taking Feminizing Hormone Therapy for the Purpose of Gender Transition
A Systematic Scoping Review
📑 Direct Link
"Much of the literature to date describing histologic findings in transgender women comes from the examination of genitourinary specimens removed during feminizing surgeries. Common benign changes associated with feminizing hormone therapy include the development of acini and lobules in the breast, testicular tubular changes, and squamous metaplasia of the prostate and urethra. Neoplastic cases include breast adenocarcinoma and fibroepithelial lesions, testicular germ cell tumors, prostatic adenocarcinoma, anal squamous cell carcinoma, pituitary adenomas, and meningiomas. Additional studies assessing the findings in other organ systems as well as population-based studies assessing rates of neoplasia are needed."
Author: Andrews AR, Kakadekar A, Schmidt RL, Murugan P, Greene DN.
Publication: Archives of Pathology & Laboratory Medicine. 2022 Jan;146(2):252–261.
Date: 13 May 2021
DOI: 10.5858/arpa.2020-0704-RA
Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women
📑 Direct Link 🔓 Free Article
"This systematic review has shown that well‐designed, sufficiently robust randomised controlled trials (RCTs) and controlled‐cohort studies do not exist, and are needed, to assess the benefits and harms of hormone therapies (used alone or in combination) for transgender women in transition. The following questions should be addressed via RCTs and cohort studies: What are the short‐, medium‐, and long‐term effects (including adverse effects, benefits, and prognoses) of estradiol therapy alone, as opposed to combination therapy using estradiol together with cyproterone acetate or spironolactone? What is the short‐, medium‐, and long‐term clinical efficacy of hormone therapy when applied orally, transdermally, and intramuscularly?" "Other studies from the 1980s and 90s reported that there were adverse effects from high‐dose estradiol, but these studies used ethinyl estradiol or equine premarin (equine estradiol) instead of bioidentical 17‐beta‐estradiol; and used progestins, instead of bioidentical progesterone. This may have contributed to the adverse effect profile of these specific treatments (Prior 1989). Unlike the bioidentical alternatives used today (hormone preparations made from plant sources that are similar or identical to human hormones), substances administered in the past (e.g. equine oestrogens, ethinyl estradiol) were associated with more diverse adverse effects like thrombophilia, cardiovascular problems, breast and prostate cancer, as well as liver, adrenal gland and neural dysfunction."
Author: Haupt C, Henke M, Kutschmar A, Hauser B, Baldinger S, Saenz SR, Schreiber G.
Publication: Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD013138
Date: 1 May 2018
DOI: 10.1002/14651858.CD013138.pub2
Hormonal Treatment of Transgender Women with Oral Estradiol
📑 Direct Link 🔓 Free Article
"We analyzed data on all transgender females seen in our clinic since 2008 treated with oral estradiol. We looked at the success of achieving serum levels of testosterone and 17-β estradiol in the normal range on various doses of estradiol (with and without antiandrogens spironolactone and finasteride).
Results: There was a positive correlation between estradiol dose and 17-β estradiol, but testosterone suppression was less well correlated. Over 70% achieved treatment goals (adequate 17-β estradiol levels and testosterone suppression) on 4 mg daily or more. Nearly a third of patients did not achieve adequate treatment goals on 6 or even 8 mg daily of estradiol. Spironolactone, but not finasteride, use was associated with impairment of obtaining desired 17-β estradiol levels. Spironolactone did not enhance testosterone suppression, and finasteride was associated with higher testosterone levels."
Author: Leinung MC, Feustel PJ, Joseph J.
Publication: Transgender Health. 2018;3(1):74-81
Date: 1 May 2018
DOI: 10.1089/trgh.2017.0035
Prostate Health
Prostate Cancer UK Other Prostate Problems in Trans Women
"The information on this page is based on research about trans women. But some of it will be relevant to non-binary and intersex people who’ve had gender affirming surgery or taken feminising hormones."
"The most common prostate problems are: enlarged prostate, prostatitis (inflammation of the prostate), prostate cancer. An enlarged prostate and prostatitis are non-cancerous (benign) conditions. Below, we provide some information about these conditions in trans women."
Facial Feminization Surgery (FFS)
🍁 Script What you need to know about Facial Feminization Surgery recovery
"How quickly and efficiently a person’s body recovers from surgery is always an individual affair, and that’s especially true for something like FFS. Recovery from rhinoplasty is going to look quite different from recovering from forehead contouring. Dr. Eric Bensimon, a Montreal-based surgeon who has over 20 years of experience with FFS, says the level of post-surgical discomfort can vary, depending on the procedures a patient opts for."
🍁💬 Script Ce qu’il faut savoir sur la convalescence après une chirurgie de féminisation faciale
💬 "La rapidité et l’efficacité avec lesquelles le corps d’une personne se remet d’une intervention chirurgicale dépendent toujours de l’individu, et cela est particulièrement vrai pour une intervention comme la CFF. La convalescence après une rhinoplastie sera très différente de celle qui suit un remodelage du front. Le Dr Eric Bensimon, un chirurgien de Montréal qui compte plus de 20 ans d’expérience en chirurgie du visage, explique que le niveau d’inconfort postopératoire peut varier en fonction des interventions choisies par la personne."
Facial Feminization Surgery Research
Perioperative Estrogen Hormonal Therapy Does Not Increase Venous Thromboembolism Risk in Facial Feminization Surgery
📑 Direct Link 🔓 Open Access
"Conflicting data exist regarding increased perioperative venous thromboembolism (VTE) risk with feminizing hormone therapy. The effect has been poorly studied within the transgender population. Acute perioperative cessation of feminizing hormone therapy often leads to unpleasant side effects and exacerbates gender dysphoria in the perioperative period. The authors sought to identify VTE incidence in patients undergoing facial feminization surgery while continuing hormone replacement therapy throughout the time of surgery." "Perioperative use of feminizing hormonal therapy does not increase risk for perioperative VTE in patients undergoing facial feminization surgery. Therefore, it is reasonable to continue these medications through the time of surgery."
Author: Li, Alexander Y. MD, MS; Park, Matthew J. BA; Fick, Jennifer FNP-C; Ousterhout, Douglas K. MD, DDS; Deschamps-Braly, Jordan C. MD
Publication: Plastic and Reconstructive Surgery 154(6):p 1309-1315, December 2024
Date: Dec 2024
DOI: 10.1097/PRS.0000000000011437
🍁 Facial Feminization: Perioperative Care and Surgical Approaches Direct Link 🔓 Free Article
"After studying this article, the participant should be able to: 1. Understand the regional anatomy involved in facial feminization surgery, the key differences between the male and female face, and surgical approaches for modification. 2. Appreciate the integration of preoperative virtual planning and nonoperative approaches for facial feminization care. 3. Understand the perioperative process and potential complications and sequela. 4. Understand the importance of transgender care acceptance as it pertains to clinical outcomes."
Author: Ellis, Marco MD; Choe, Joshua MS; Barnett, Sarah L. BA; Chen, Kevin MD; Bradley, James P. MD
Publication: Plastic and Reconstructive Surgery 153(1):p 181e-193e, January 2024
Date: Jan 2024
DOI: 10.1097/PRS.0000000000010886
Vaginoplasty and Vulvoplasty
Vaginoplasty and Vulvoplasty Research
Outcomes and Experience of Gender-Confirming Vulvoplasty: A Systematic Review Journal Link
"Genital gender-affirming surgery, or bottom surgery, is a medically necessary treatment for some transgender and gender diverse (TGD) individuals. Techniques and outcomes of penile inversion vaginoplasty are the most well-documented type of feminizing bottom surgery in the literature. The outcomes of vulvoplasty, in which no vaginal canal is created, are less clear. The aim of this study was to systematically review the literature on outcomes and experience of vulvoplasty."
Author: Aaen EK, Højgaard AD, Pop ML, Kesmodel US
Publication: Transgender Health. 2024;0(0)
Date: 30 Sep 2024
DOI: 10.1089/trgh.2023.0231
🍁 Gynecological concerns and vaginal practices and exposures among transfeminine individuals who have undergone vaginoplasty
📑 Direct Link 🔓 Open Access
"A total of 60 transfeminine participants 18+ years of age, living in Canada, and who had undergone vaginoplasty at least 1 year prior were recruited through social media, community groups, healthcare provider referrals, and study recontact. Participants completed a cross-sectional, online questionnaire detailing demographics, gynecological concerns, and genital practices and exposures." "Transfeminine individuals reported a range of gynecological concerns outside of the surgical healing period. Genital practices/exposures varied across clusters, but no clear associations between clusters and symptoms were identified; instead, practice/exposure clusters were dependent on where the individual underwent vaginoplasty."
Author: Jason Hallarn, Greta R Bauer, Emery Potter, Hannah Wilcox, Jacy Newfeld, Yonah Krakowsky, Jacques Ravel, Jessica L Prodger
Publication: The Journal of Sexual Medicine, Volume 20, Issue 11, November 2023, Pages 1344–1352
Date: 11 Sep 2023
DOI: 10.1093/jsxmed/qdad109
Cosmetic Revision Surgeries after Transfeminine Vaginoplasty
📑 Direct Link 🔓 Open Access
"Cosmetic revision surgeries after transfeminine vaginoplasty are frequent. In our large and long-term cohort study, labiaplasty followed by clitoroplasty were found as the most required cosmetic revision surgical procedures. Further multicentre, prospective and controlled studies are necessary to improve cosmetic outcomes and scientific evidence after transfeminine vaginoplasty."
Author: Mañero, I., Arno, A.I., Herrero, R. et al.
Publication: Aesth Plast Surg 47, 430–441 (2023)
Date: 24 Aug 2022
DOI: 10.1007/s00266-022-03029-9
Complications postopératoires après transformation génitale homme-femme (aidoiopoiëse)
💬 Journal Link
💬 "La chirurgie de transformation génitale homme vers femme, réalisée le plus fréquemment par la technique classique de l’inversion pénienne, consiste en la création d’une cavité vaginale, du clitoris, de petites et grandes lèvres, et d’un méat urinaire périnéal, à partir des organes génitaux externes masculins existants chez une femme Trans. Les complications postopératoires après aidoiopoëse, aussi appelée vaginoplastie, sont fréquentes. Ces complications peuvent être fonctionnelles ou esthétiques et concerner toutes les parties anatomiques constituant la néo-vulve : vagin, urètre, clitoris, petites et grandes lèvres. Les patientes doivent en être soigneusement informées en préopératoire. Une éducation thérapeutique ainsi qu’un suivi rapproché durant toute la durée de la cicatrisation sont fondamentaux pour accompagner les patientes, dépister et traiter ces complications si nécessaire."
Auteur: S. Cristofari, M. Revol
Publication: Annales de Chirurgie Plastique Esthétique Volume 64, Issues 5–6, pg 667-673, November 2019
Date: 5 Oct 2019
DOI: 10.1016/j.anplas.2019.07.003
Does Depth Matter? Factors Affecting Choice of Vulvoplasty Over Vaginoplasty as Gender-Affirming Genital Surgery for Transgender Women Journal Link
"We report demographic data and the reasons for choosing vulvoplasty as gender-affirming surgery for patients who either completed or were scheduled for surgery, in addition to patient reports of satisfaction with choice of surgery, satisfaction with the surgery itself, and sexual activity after surgery. Results: In total, 486 patients were seen in consultation for trans-feminine gender-affirming genital surgery: 396 requested vaginoplasty and 39 patients requested vulvoplasty. 30 Patients either completed or are scheduled for vulvoplasty. Vulvoplasty patients were older and had higher body mass index than those seeking vaginoplasty. The majority (63%) of the patients seeking vulvoplasty chose this surgery despite no contra-indications to vaginoplasty. The remaining patients had risk factors leading the surgeon to recommend vulvoplasty. Of those who completed surgery, 93% were satisfied with the surgery and their decision for vulvoplasty."
Author: David Jiang, MD, Jonathan Witten, MD, Jens Berli, MD, Daniel Dugi, III, MD, FACS
Publication: The Journal of Sexual Medicine, Volume 15, Issue 6, June 2018, Pages 902–906
Date: 26 April 2018
DOI: 10.1016/j.jsxm.2018.03.085
🍁 Rainbow Health Ontario Trans Primary Care: Masculinizing Hormone Therapy
"The cornerstone of hormone therapy for trans masculine patients is testosterone. The goal of treatment is virilization – the development of masculine secondary sexual characteristics."
🍁🥔 GAC PEI
📑 Quick Reference Sheet: Masculinizing Hormone Therapy
"These guidelines do not present it as a ‘Standard of Care’ but instead as a guide to help clinicians in their day-to-day practice. Adaptations may be considered based on each
patient’s unique circumstances. Clinicians must use their own expertise and decision-making skills within each clinical encounter."
🍁 Trans Care BC Testosterone-based hormones
"Testosterone-based therapies are also known as “masculinizing hormones.” To be more inclusive of diverse gender identities, we are using language that focuses on anatomy, treatments, goals and presenting concerns, rather than gender. Testosterone is a hormone that is used to induce secondary sex characteristics like beard growth and a deepened voice. It also reduces estrogen-related features, such as a rounder face shape or body fat around the hips and buttocks. This page describes the advantages and disadvantages, expected effects, and potential risks of common testosterone therapies. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you."
Gender Affirming Care at UC San Francisco Information on Testosterone Hormone Therapy
"This document will provide an overview of gender affirming masculinizing hormone therapy, including choices, risks, and unknowns associated with testosterone therapy."
FOLX Health What Physical Changes to Expect on Testosterone Hormone Replacement Therapy, Explained by FOLX
"Many people report feeling more relaxed and at ease in their bodies after starting HRT. Testosterone therapy can greatly alleviate gender dysphoria, affirm your identity, and help you feel more joyous in your experience of yourself and the world. We know that many people’s first question is what physical changes to their body they can expect to see on testosterone HRT. With that in mind, we’ve mapped out a generalized timeline for the secondary sex characteristics you might see and when."
Effect of 100 mg of testosterone cypionate in trans men with erythrocytosis: a randomized controlled pilot study Journal Link
"Testosterone cypionate is commonly administered at 200 mg every 2 weeks to facilitate masculinization in transgender men. However, this regimen may increase hematocrit (Hct) by up to 6.9%." "Testosterone suspension appears to be more effective in reducing Hct than dose reduction when a decrease greater than 1% in Hct is desired. Nonetheless, dose reduction preserved therapeutic testosterone levels while offering additional benefits in blood pressure, anxiety, and body weight."
Author: Sérgio Henrique Pires Okano, Silvio Antônio Franceschini, Débora Aiesha Leite Cantelli, Ana Carolina Japur de Sá Rosa e Silva, Rui Alberto Ferriani, Luiz Gustavo Oliveira Brito, Lúcia Alves da Silva Lara
Publication: The Journal of Sexual Medicine, Volume 22, Issue 11, November 2025, Pages 2149–2153
Date: 6 Oct 2025
DOI: 10.1093/jsxmed/qdaf263
Menstrual Care
FOLX Health Does Testosterone Stop Periods?: Menstruation, Menopause, Phantom Periods, and GAHT/HRT
"Transgender men, nonbinary people, and other gender variant people can menstruate, too. Gender identities and bodies beyond these ones also can experience premenstrual syndrome (PMS) symptoms as well. Gender-affirming hormone therapy (GAHT), also referred to as hormone replacement therapy (HRT), can impact menstrual periods and cycles overall. People on testosterone GAHT/HRT may stop bleeding every month as a result of taking HRT. Additionally, those on estrogen GAHT/HRT (or anti-androgens such as progesterone) may experience PMS symptoms, despite not bleeding. Read on for what you need to know when it comes to menstruation and transgender health."
International Association for Premenstrual Disorders Transgender & PMDD
"Transgender individuals with PMDD often do not receive the support that they need and deserve. Anyone who has an ovary/ovaries can have PMDD. At IAPMD, we are committed to providing support, education, and advocacy for all individuals living with PMDD/PME regardless of gender identity or expression. We believe no one should go through this journey alone, and we are here to support you."
🍁 The Canadian Premenstrual Disorders Association
"The Canadian Premenstrual Disorders Association was founded by individuals who live with premenstrual disorders and understand the barriers surrounding diagnosis, treatment, and social understanding. Their experiences revealed a major gap in Canadian resources, support networks, and public awareness related to menstrual mental health. Because of this lived experience foundation, the organization prioritizes community voices and focuses on creating spaces where people share experiences, learn from one another, and find validation. This approach helps ensure support efforts reflect real needs expressed by those affected by PMDD, PMS, and related disorders."
Progressive Therapeutic Counselling The Intersection of PMDD and Gender Identity
"While PMDD has traditionally been discussed within the context of cisgender women, its impact on non-binary and transgender individuals remains underrepresented. This article aims to comprehensively explore the intersection between PMDD and gender identity, with an emphasis on gender dysphoria, healthcare challenges, and systemic biases in medical research."
Premenstrual Dysphoric Disorder (PMDD): A gender-affirming guide
"Premenstrual Dysphoric Disorder (PMDD) is a severe and chronic medical condition that impacts millions of individuals worldwide. This page is dedicated to providing a comprehensive overview of PMDD from a gender-affirming and gender-neutral perspective. Whether you are newly diagnosed, supporting a loved one, or seeking to expand your knowledge, our aim is to inform, educate, advocate, and build a supportive community."
Menstrual Research
Menstrual management in transgender and gender diverse individuals: psychiatric and psychosocial considerations
📑 Direct Link 🔓 Open Access
"Until recently, the mainstream menstrual discourse has failed to capture the experience of transmenstruators. However, a better understanding of the menstrual experiences of TGD-AFAB will allow for more individualized patient-centered care. In this review, we provide the relevant data necessary to inform the psychiatric management of menstruation in TGD-AFAB individuals, including experiences of menstruation, preferences for menstrual management, and the impact on mental health. Our review indicates that menstrual care in TGD patients must be tailored to the individual; clinicians should remain open-minded to the unique experience of transmenstruators; gender-affirming menstrual care is necessary to reduce psychological burden."
Author: Arshed A, Madanes S, Pottinger S, Ackerman MG and Deutch AB
Publication: Front. Psychiatry 15:1422333
Date: 28 Oct 2024
DOI: 10.3389/fpsyt.2024.1422333
Management of breakthrough bleeding in transgender and gender diverse individuals on testosterone Journal Link
"Other than hysterectomy, which was fully successful at managing breakthrough bleeding, no approach was significantly better than no intervention. This was true both for individuals who did and did not bleed with missed testosterone doses. Regardless of what approach was used, after a failed attempt, the next attempt was successful in more than half of individuals. Of the 16 who underwent hysterectomy, 1 did so in part as a first line approach to manage breakthrough bleeding."
Author: Frances W. Grimstad, MD, MSa, Elizabeth R. Boskey, PhD, MPH, MSSW, Rachael S. Clark, MD, MTS, Cecile A. Ferrando, MD, MPH
Publication: American Journal of Obstetrics and Gynecology, Volume 231, Issue 5 p534.e1-534.e11 November 2024
Date: 12 June 2024
DOI: 10.1016/j.ajog.2024.06.004
Incidence of breakthrough bleeding in transgender and gender-diverse individuals on long-term testosterone Journal Link
"Although 58 people underwent a hysterectomy during the follow-up period, 64% of the cohort who maintained a uterus eventually experienced breakthrough bleeding. The median time to the initial bleeding episode was 22 months (interquartile range, 12–201) after testosterone initiation.
Conclusion: These results suggest that a substantial fraction of transgender and gender-diverse individuals who are using testosterone will experience at least 1 episode of breakthrough bleeding even after their initial year of testosterone use. We recommend that clinicians inform all patients that breakthrough bleeding is a common occurrence even after the first year on testosterone therapy."
Author: Frances W. Grimstad, MD, MSa, Elizabeth R. Boskey, PhD, MPH, MSSW, Rachael S. Clark, MD, MTS, Cecile A. Ferrando, MD, MPH
Publication: American Journal of Obstetrics and Gynecology, Volume 230, Issue 4 p434.e1-434.e10 April 2024
Date: 3 Jan 2024
DOI: 10.1016/j.ajog.2023.12.036
"Despite high co-morbidity between premenstrual dysphoric disorder and mood disorders, there is a gap of research-based tools to monitor concurrent premenstrual and mood symptoms. In this study, we developed a new DSM-5-based questionnaire to prospectively monitor concurrent premenstrual and mood symptoms."
Author: Frey, B.N., Allega, O.R., Eltayebani, M. et al.
Publication: BMC Women's Health 22, 96 (2022)
Date: 30 March 2022
DOI: 10.1186/s12905-022-01678-1
Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents
📑 Direct Link 🔓 Open Access
"The treatment of persistent uterine bleeding in those patients who identify as transmasculine or nonbinary is often straightforward, but can be difficult in a subset of patients. This article reviews the physiology of the normal menstrual cycle and the hormonal influences on the endometrium, and then explores options for the treatment of persistent bleeding for people both already on testosterone and for those who are either not ready for or who do not desire testosterone."
Author: Carswell JM, Roberts SA
Publication: Transgender Health. 2017;2(1):195-201
Date: 1 Nov 2017
DOI: 10.1089/trgh.2017.0021
Sex Hormone–Sensitive Gene Complex Linked to Premenstrual Mood Disorder Press Release
"“We found dysregulated expression in a suspect gene complex which adds to evidence that PMDD is a disorder of cellular response to estrogen and progesterone,” explained Peter Schmidt, M.D. of the NIH’s National Institute of Mental Health, Behavioral Endocrinology Branch. “Learning more about the role of this gene complex holds hope for improved treatment of such prevalent reproductive endocrine-related mood disorders.”"
Publication: The National Institute of Mental Health
Date: 3 Jan 2017
FOLX Health Top Surgery 101: Procedures, Cost, and Safety
"Top surgery is one of the most common gender-affirming surgeries for transmasculine people, transgender men, and non-binary people. Top surgery is a procedure that involves removing the breasts (commonly known in the cis community as a bi-lateral mastectomy) and may also include chest contouring, nipple grafts, or nipple and areola resizing and repositioning to achieve a flatter, or, what one might call a more “masculine” looking, chest. Gender-affirming surgeries such as top surgery can improve quality of life for transgender people and help resolve some of the more debilitating effects of gender dysphoria. Studies consistently show that most transmasculine people are satisfied with their results after surgery."
Mastectomy Research
Improved health–related quality of life and gender congruence after gender-affirming mastectomy—a prospective cohort study
📑 Direct Link 🔓 Open Access
"Aim: To prospectively investigate how GAM affects health–related quality of life (HRQoL) and gender congruence in transgender men and non–binary individuals."
"A statistically significant improvement was observed (P < .00625) in the SF-36 domains related to emotional well-being, as well as in the domains vitality and bodily pain, when comparing baseline with 12-36 months postoperatively."
Author: Isak Gran, Alexander Kamali, Fredrik Granath, Louise Frisén, Ebba K Lindqvist, Cecilia Dhejne, Pehr Sommar, Helena Sackey
Publication: The Journal of Sexual Medicine, Volume 22, Issue 10, October 2025, Pages 1882–1890
Date: 10 Aug 2025
DOI: 10.1093/jsxmed/qdaf203
Nipple-Preserving Inferior-Ellipse Mastectomy: A New Technique for Gender-Affirming Top Surgery Journal Link
"The 2 most common techniques for gender-affirming mastectomy are the double-incision free nipple graft and periareolar techniques. However, some patients are not well suited for either technique. When the nipples are high and on the pectoralis muscle, but there is marked breast tissue and skin redundancy, a double-incision free nipple graft would land the incision above the pectoral shadow, but a periareolar approach would not adequately remove the excess skin. In these patients, a nipple-preserving inferior-ellipse incision allows for appropriate chest contouring, leaving the nipple position unchanged and placing the incision in the pectoralis muscle shadow."
Author: Robinson, Isabel S. MD; Salibian, Ara MD; Zhao, Lee C. MD; Bluebond-Langner, Rachel MD
Publication: Plastic and Reconstructive Surgery 154(2):p 237e-240e, August 2024.
Date: Aug 2024
DOI: 10.1097/PRS.0000000000011046
Chirurgie mammaire de réassignation vers le sexe masculin : étude rétrospective de la satisfaction des patients transsexuels après mastectomie
💬 Journal Link
💬 "L’ensemble des 22 patients opérés entre janvier 2012 et mars 2013 pour mastectomie bilatérale de réassignation ont été contacté par courrier pour être inclus dans l’étude. La satisfaction après intervention était mesurée par auto-questionnaire adapté du questionnaire de reconstruction mammaire du Q-Breast modifié pour la chirurgie de réassignation sexuelle. Un score global supérieur à 320/378 était considéré comme « tout à fait satisfaisant ». Résultats: Seize patients sur 22 (73 %) ont répondu au questionnaire. Le score moyen était de 332/378, correspondant à un résultat « tout à fait satisfaisant ». Le score d’évaluation du bien-être psychologique était de 54,5/60."
Auteur: B. Bertrand, A.-S. Perchenet, T.R. Colson, D. Drai, D. Casanova
Publication: Annales de Chirurgie Plastique Esthétique, August 2017, Volume 62, Issue 4 pg 303-307
Date: 14 July 2017
DOI: 10.1016/j.anplas.2017.05.005
Phalloplasty and Metoidioplasty (Bottom Surgery)
Phallo.net
"Phalloplasty is a gender-affirming surgery that creates a penis using tissue from another part of the body. It can result in a sensate penis, with erogenous and/or tactile sensation, as well as rigidity for sexual intercourse and the ability to urinate while standing.
How Phalloplasty Works: Phalloplasty surgeons construct the penis using tissue taken from a donor site such as the forearm, thigh, back, abdomen, or hip/groin. FTM Phalloplasty may also include procedures like vaginectomy, urethral lengthening, scrotoplasty, glansplasty, and penile implant surgery. Outcomes today are often exceptional, with significant improvements in both appearance and function thanks to decades of surgical advancement."
FTM Phalloplasty Surgery Procedures
"The development of procedures for phalloplasty has followed those of general reconstructive surgery. Bogoras first reported a total penile reconstruction using a tubularized pedicled abdominal flap in 1936. Several different procedures with local flaps followed. In the 1980s, the introduction of microvascular free flaps transfer started a new era of reconstructive surgery which had a great impact on phalloplasty. Free flap phalloplasty is now the more common approach, though some surgeons and patients still prefer local flap techniques."
Metoidioplasty.net
"Metoidioplasty is a gender-affirming surgery that creates a small-sized phallus using existing genital tissue. Metoidioplasty is a good option for those with sufficient clitoral growth from being on testosterone hormone replacement therapy. It's a less invasive and more affordable surgery than Phalloplasty. Average penis length from a "Meta" is 1.5-2 inches.
How Metoidioplasty Works: Hormone Replacement Therapy, in the form of Testosterone and Dihydrotestosterone (DHT), gradually enlarges the natal clitoris, which is analogous to the penis. Metoidioplasty surgery involves cutting the surrounding labial tissues, and in some cases the suspensory ligament, to "free up" and reposition the clitoris in a more forward position, to more closely approximate the position of a penis. Complimentary procedures are optional, such as Vaginectomy, Urethral Lenghtening, Scrotoplasty and testicular implants."
Metoidioplasty Surgery Procedures
"Metoidioplasty is a gender-affirming genital surgery for transmasculine and nonbinary individuals that creates a small, functional penis (neophallus) using the hormonally enlarged clitoris. Originally developed in the 1980s as a less invasive alternative to phalloplasty, metoidioplasty prioritizes preserved sensation, natural erection, and lower surgical complexity. The average penis length after metoidioplasty is typically 3.8 to 5 cm (1.5 to 2 inches), depending on anatomy, testosterone response, and the surgical technique used. While several methods exist, most do not significantly increase length. In fact, a 2023 study found that the post-metoidioplasty neophallus was, on average, only 0.6 cm longer than the pre-operative stretched clitoral length. Each approach offers different advantages depending on patient goals."
Assessment of neophallus length following metoidioplasty
📑 Direct Link 🔓 Open Access
"Patients considering metoidioplasty often wonder how large their neophallus will be. We found that patients can expect exposed neophallus length to be about 0.6 cm longer than their pre-operative stretched clitoral length. No evidence of association of time on testosterone nor BMI with exposed neophallus length was found. This information is crucial for gender diverse patients to make informed decisions about gGAS."
Updates on metoidioplasty
📑 Direct Link 🔓 Open Access
"Metoidioplasty presents a variant of phalloplasty in transmen who require simple and safe genital gender affirmation surgery (GAS). The aim is to evaluate updates on the technique, as well as personal experience."
Author: Stojanovic B, Djordjevic ML
Publication: Neurourol Urodyn. 2023;42:956-962
Date: 20 Nov 2022
DOI: 10.1002/nau.25102
Masculinizing gender-affirming surgery for trans men and non-binary individuals: what you should know
📑 Direct Link 🔓 Open Access
" Because of the improved accessibility to gender-affirming surgery (GAS), many providers will care for patients during and after gender transition. For trans men (female-to-male), GAS represents a combination of procedures rather than a single surgery. The particular combination of masculinizing procedures is chosen on the basis of informed patient-provider discussions regarding the patient’s goals and anatomy and implemented through a multidisciplinary team approach. In this review, we describe the common procedures comprising masculinizing GAS to improve delivery of specialized care for this patient population."
Author: Darshan P. Patel, M.D., Isak A. Goodwin, M.D., Omer Acar, M.D., Ervin Kocjancic, M.D., James M. Hotaling, M.D., M.S.
Publication: Fertility and Sterility, 2021; 116, 924-930
Date: Oct 2021
DOI: 10.1016/j.fertnstert.2021.07.004
The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series
📑 Direct Link 🔓 Open Access
"Some transgender men express the wish to undergo genital gender-affirming surgery. Metoidioplasty and phalloplasty are procedures that are performed to construct a neophallus. Genital gender-affirming surgery contributes to physical well-being, but dissatisfaction with the surgical results may occur. Disadvantages of metoidioplasty are the relatively small neophallus, the inability to have penetrative sex, and often difficulty with voiding while standing. Therefore, some transgender men opt to undergo a secondary phalloplasty after metoidioplasty. Literature on secondary phalloplasty is scarce."
🍁"Transgender men who underwent secondary phalloplasty after metoidioplasty were retrospectively identified in 8 gender surgery clinics (Amsterdam, Belgrade, Bordeaux, Austin, Ghent, Helsinki, Miami, and Montreal). Preoperative consultation, patient motivation for secondary phalloplasty, surgical technique, perioperative characteristics, complications, and clinical outcomes were recorded."
Author: Muhammed Al-Tamimi, Garry L. Pigot, Wouter B. van der Sluis, Tim C. van de Grift, R. Jeroen A. van Moorselaar, Margriet G. Mullender, Romain Weigert, Marlon E. Buncamper, Müjde Özer, Kristin B. de Haseth, Miroslav L. Djordjevic, Christopher J. Salgado, 🍁Maud Belanger, Sinikka Suominen, Maija Kolehmainen, Richard A. Santucci, Curtis N. Crane, Karel E.Y. Claes, Stan Monstrey, Mark-Bram Bouman
Publication: The Journal of Sexual Medicine, Volume 16, Issue 11, November 2019, Pages 1849–1859
Date: 18 Sep 2019
DOI: 10.1016/j.jsxm.2019.07.027
Gender Affirming Care at UC San Francisco Approach to genderqueer, gender non-conforming, and gender nonbinary people
"As with people who have binary transgender identities, the process of gender affirmation and transition for those who are nonbinary is for some limited to an internal or purely social process; for others the process may involve a variety of gender affirming medical and/or surgical interventions. The WPATH Standards of Care Version 7 are now more inclusive of GNB identities and recognize the need for and appropriateness of an individualized approach."
"Drawing on the author's own experiences as a nonbinary person, as well as interviews and research, it shares common experiences and challenges faced by those who are nonbinary, and what friends, family and other cisgender people can do to support them. Breaking down misconceptions and providing definitions, the history of nonbinary identities and gender-neutral language, and information on healthcare, this much-needed guide is for anyone wanting to fully understand nonbinary and genderqueer identities."
Research
Gender Affirming Medical Treatment Desire and Treatment Motives in Binary and Non-Binary Transgender Individuals
📑 Direct Link 🔓 Open Access
"It is currently unknown whether there are differences in desire for gender affirming medical treatment (GAMT) between binary and non-binary transgender individuals, although the latter seek treatment less prevalently." "This study was the first to systematically investigate differences in treatment desire motives between binary and non-binary transgender individuals, while also showing the possible negative consequences of an unfulfilled treatment desire. Given the online character of the study, results may not generalize to the broader transgender community. Conclusion: Similarly to binary transgender individuals, many non-binary transgender individuals have a desire for GAMT, and not being able to receive GAMT has a negative effect on their mental and sexual health. Further efforts should be made to make GAMT accessible for all transgender individuals, regardless of gender identity."
Author: Mathilde Kennis, Felix Duecker, Guy T’Sjoen, Alexander T. Sack, Marieke Dewitte
Publication: The Journal of Sexual Medicine, Volume 19, Issue 7, July 2022, Pages 1173–1184
Date: 10 April 2022
DOI: 10.1016/j.jsxm.2022.03.603
Health of Non-binary and Genderqueer People: A Systematic Review
📑 Direct Link 🔓 Open Access
"Non-binary and genderqueer (NBGQ) people are those who do not identify within the gender binary system (male vs. female), not falling exclusively in man/male or woman/female normative categories. A higher proportion of NBGQ people is usually found within young persons. This population is marginalized and, as such, is at risk of stigmatization and of developing negative health outcomes. As literature on the health of NBGQ people is sparse, this study aims at systematically review the limited studies on this field. Methods: The research questions which guided the systematic review were: (1) What are the differences in the health levels between NBGQ and binary transgender (BT) individuals? (2) What are the differences in the health levels between NBGQ and cisgender individuals? (3) Which medical and psychological interventions are most suitable for improving NBGQ health?"
Author: Scandurra C, Mezza F, Maldonato NM, Bottone M, Bochicchio V, Valerio P and Vitelli R
Publication: Front. Psychol. 10:1453.
Date: 24 June 2019
DOI: 10.3389/fpsyg.2019.01453
Unanticipated: Healthcare Experiences Of Gender Nonbinary Patients And Suggestions For Inclusive Care Direct Link 🔓 Open Access
"Results of this study indicate that gender nonbinary people often feel invisible and unwelcome in health settings, due in part to widespread assumptions of gender and sex’s inseparable and binary natures, and that this discomfort in health settings, as well as economic and geographical factors, may negatively impact nonbinary patients’ access to healthcare. Suggestions for improved care include increased education of providers on trans and gender nonbinary identities and health needs, inclusion of non-binary gender and pronoun options on intake forms and medical records, and de-emphasizing gender in healthcare."
Author: Hannah Mogul-Adlin
Publication: Public Health Theses. 1197.
Date: 2015
EliScholar:Link
Hormone Replacement Therapy
FOLX Health Microdosing (Low Dose) Estrogen HRT
"Low-dose, or microdosing estrogen, is a way for those to experience slower, more subtle changes on hormone therapy (known as HRT or GAHT). Many people live outside the gender binary of woman and man. Nonbinary folks and other gender-expansive people within or beyond the binary can explore bodily changes in different ways, including starting gender-affirming hormone therapy (GAHT). GAHT is sometimes referred to as hormone replacement therapy or HRT."
Microdosing (Low Dose) Testosterone HRT
"For folks seeking subtle, slower changes on testosterone, microdosing is a wonderful option. Many live somewhere on the gender spectrum beyond male and female. Nonbinary and gender-variant experiences (many that fall within the transgender umbrella) within or beyond the binary can entail exploring bodily changes in all different ways. Many along the gender spectrum may be considering taking or are currently taking testosterone gender-affirming hormone therapy (GAHT) as a tool for their body to reflect their truest self."
Vice: A Beginner’s Guide to Microdosing Testosterone During Your Transition
"As they and I both knew: It’s hard to know where to look for information about transitioning—or any aspect of medical care—when you’re non-binary, except asking other non-binary people about it. Trans and non-binary people are underdiagnosed and undertreated in every medical sense, not just in terms of their gender-related care: Twenty-three percent report not seeing a doctor when they need to for fear of mistreatment and 50 percent report needing to teach their providers about their gender identity. Almost none of the research about AFAB people’s medical transitions accounts for non-binary approaches to transition like microdosing. That’s what we know about on paper: just about nothing. Many standardized guides for hormone replacement therapy now include the word “non-binary,” but many providers remain resistant to any understanding of mine as a real identity, let alone how to care for people like me."
Gender Affirming Surgery
Phallo.net: Non-Binary Options for Phalloplasty
"People who identify as non-binary represent a substantial and growing population within the LGBTQ community. Historically, gender-affirming bottom surgery has been binary in nature: Female to Male or Male to Female. However, there's an increasing number of Phalloplasty Surgeons who offer an individualized approach to Phalloplasty for non-binary people seeking bottom surgery." "People who identify as non-binary may want hormones and surgery, hormones but not surgery, surgery but not hormones, or neither hormones or surgery. In one study, 77.2% of non-binary participants indicated that they had some interest in using hormones or surgery to alleviate gender dysphoria. For non-binary people who are seeking gender-affirming Phalloplasty, there are a number of different surgical options to consider."
Metoidioplasty.net: Non-Binary Options for Metoidioplasty
"People who identify as non-binary represent a substantial and growing population within the LGBTQ community. Historically, gender-affirming bottom surgery has been binary in nature: Female to Male or Male to Female. However, there's an increasing number of surgeons who offer an individualized approach to Metoidioplasty for non-binary people seeking bottom surgery."
Gender Affirming Surgery Research
Genital Gender-Affirming Surgery Requests Outside the Binary: Unique Multidisciplinary Considerations for Transgender and Gender Diverse Patients Journal Link
"This study describes genital gender-affirming surgery (GGAS) requests made beyond the binary medical approach at our institution and our multidisciplinary response to adapt current surgical pathways. We reviewed all GGAS requests from January 2016 to February 2022 to determine the number of requests outside the historical binary model of surgical offerings (n = 227). With a paucity of guidelines and outcomes to guide providers, we offer a systematic and patient-centered multidisciplinary approach to surgical evaluation that encompasses the various ways gender dysphoria and incongruence present in people of different gender expressions."
Author: Marsiglio M, Fascelli M, Peters BR, et al.
Publication: Transgender Health. 2024;0(0).
Date: 28 Oct 2024
DOI: 10.1089/trgh.2023.0199
Challenging the Binary Bias in Gender-Affirming Surgery
📑 Direct Link 🔓 Free Access
"Although many TGD people seek surgery to align with the binary paradigm, this is not true for all. People with nonbinary identities make up a large portion of the TGD community. Care needs for nonbinary people may deviate from what is conventional.2–4 Our literature scarcely mentions nonbinary identities and even more rarely presents variations in surgical procedures that fall outside of a fully binary option (eg, shaft-only phalloplasty, vulvoplasty, and other procedure subtypes).5 Instead, we continue to reinforce White ideals of what it means to be masculine or feminine, which continues the othering of those affected by colonialism and white supremacy. Plastic surgeons must avoid creating unintentional harm by perpetuating a rigid binary treatment algorithm for all TGD people that enforces a clinical narrative valuing assimilation over authenticity."
Author: Peters, Blair R. MD; Guerriero, Jess MSW; Marsiglio, Mary C. PhD; Butler, Christi MD
Publication: Plastic and Reconstructive Surgery 151(4):p 698e-699e, April 2023
Date: April 2023
DOI: 10.1097/PRS.0000000000010024
What is “Nonbinary” and What Do I Need to Know? A Primer for Surgeons Providing Chest Surgery for Transgender Patients Journal Link
"We sought to describe a single-institution experience of chest-affirming procedures performed in nonbinary patients, including patient characteristics, surgical techniques, practice pearls, and outcomes." This was an observational study of nonbinary patients who underwent “chest-affirming surgery” from 2012 to 2017. Demographic and surgical data were collected. A postoperative questionnaire assessing quality of life and body image outcomes was administered."
Author: Nick Esmonde, Aaron Heston, Breanna Jedrzejewski, Elie Ramly, Alvin Annen, Jess Guerriero, Juliana Hansen, Jens Berli
Publication: Aesthetic Surgery Journal, Volume 39, Issue 5, May 2019, Pages NP106–NP112
Date: 10 July 2018
DOI: 10.1093/asj/sjy166
Resources
🍁📑 McGill Guide for Healthcare Professionals: "Towards Affirmative Intersex Health Communication in Canada"
"While practices and medical norms are shifting towards affirmative intersex care, there is still much progress to be made and community members are still reporting adverse experiences. Intersex individuals and organizations continue to ask for improved health communication practices from healthcare providers. At the same time, healthcare providers in most specialties repeatedly point to gaps in their training regarding intersex care and the need to pursue independent supplementary training to familiarize themselves with the needs andbackground of this population. This guide is a primer for healthcare providers interested in bridging those gaps and helping to make healthcare communication more accessible, effective, relevant, and responsive."
🍁📑 Rainbow Health Ontario, Health in Focus: Intersex Health
"This Health in Focus educational resource was created to highlight the healthcare needs of intersex people. This document will help you identify the issues facing intersex people in health care and social services, while grounding you in an understanding of experiences faced by intersex people throughout their lives within the healthcare sector."
interACT: Intersex Medical Resources
"Intersex people have unique healthcare needs, but still face discrimination in doctors’ offices, a lack of knowledgeable care, and medical mistreatment. There is a long history of medical abuse in attempts to prevent or “cure” intersex differences. Intersex infants and children are still subjected to nonconsensual surgeries; non-lifesaving procedures to change natural variations in genital appearance or reproductive anatomy. These surgeries can result in serious lifelong emotional and physical consequences and high complication rates. Attempts to “fix” intersex differences are rooted in ideas about gender and sexuality, and what “normal” looks like. interACT believes all intersex people deserve respectful, knowledgeable, and consensual healthcare. We offer guides for providers looking to improve intersex care, policy recommendations for hospitals, and guidance for intersex people and their families as they advocate for their own care."
Author: Jay Kyle Petersen Published: 21 Dec 2020 ISBN, Print: 9781785926310 ISBN, Digital: 9781785926327
"This comprehensive yet accessible resource provides readers with everything they need to know about intersex - people who are born with any range of sex characteristics that might not fit typical binary notions about male and female bodies.
Covering a wide variety of topics in an easy-to-read way, the book explores what intersex is, what it is not, a detailed overview of its 40 or so different variations, historical and social aspects of intersex and medical intervention, along with practical, proven advice on how professionals can help and support intersex people.
Written by an intersex man with over 65 years of first-hand experience, this book is an ideal introduction for any medical, health and social care professional or student, as well as family members and friends, seeking to improve their practice and knowledge."
Survey of Urogynecology Fellows on the Care of Patients with Differences in Sex Development/Intersex Traits Journal Link
"Patients with differences in sex development or intersex traits (DSD/I) struggle to find clinically competent care in adulthood. We sought to describe the surgical exposure of Urogynecology and Reconstructive Pelvic Surgery (URPS) fellows who had previously trained in ObGyn (URPS-Gyn) to patients with DSD/I and their interest in performing 18 relevant procedures."
Author: Grimstad, F.W., Boskey, E.R., Staffa, S.J. et al.
Publication: Int Urogynecol J 36, 599–606 (2025).
Date: 9 Jan 2025
DOI: 10.1007/s00192-024-06024-7
Fenway Health: The LGBTQIA+ Aging Project
"The LGBTQIA+ Aging Project is the premier resource in New England advocating specifically for LGBTQIA+ older adults. It is the “go to” place for organizations looking for training and technical assistance as well as individuals seeking connection and support. Since 2004, the Aging Project has trained over 10,000 elder service providers and staff in affirming and culturally competent care, supported development of LGBTQIA+ friendly community meal programs, educated healthcare professionals on the unique needs of LGBTQIA+ older adults, and advanced LGBTQIA+ equality in local and national aging policy."
The National Resource Center on LGBT Aging Resource Library
"The National Resource Center on LGBTQ+ Aging is the first U.S. technical assistance center focused on improving services for LGBTQ+ older adults, their families, and caregivers."
SAGECare
"SAGECare delivers expert LGBTQ+ aging training and consulting to providers across the U.S., Canada, and the UK. Stand out with a nationally recognized credential that showcases your team’s commitment to inclusive, culturally competent care."
General Research
Transgender patients and gender-affirming hormone therapy through the mid-life Journal Link
"While gender-affirming therapies for transgender patients are well defined and supported by organizational guidelines, including from the World Professional Association for TGD Health (WPATH) (Standards of Care 8, SOC8) and from the Endocrine Society (2017), evidence on continuation of therapy and dose adjustments into mid-life are lacking. Data from a few large cohort studies and small cross-sectional studies suggest increased risk of venous thromboembolism (VTE), stroke and myocardial infarction in those AMAB on GAHT. For those AFAB on testosterone therapy, risks of cardiovascular disease and stroke and to bone health are not well defined, given inconsistent findings from large cohort studies. Currently, the decision to continue GAHT for transgender patients is guided by patient preference along with clinician guidance."
Author: Jaya M. Mehtaa, Sarah Kanell, Charlie E.A. Borowiczc, Molly Ainsman Fisher
Publication: Maturitas Volume 189, 108093 November 2024
Date: 19 Aug 2024
DOI: 10.1016/j.maturitas.2024.108093
Illness Management in Older Lesbian, Gay, Bisexual, and Transgender Couples: A Review
📑 Direct Link 🔓 Open Access
"More openly sexually and gender diverse people are aging into later life across the world as generational transitions occur. People identifying many different ways beyond cisgender and heterosexual are diverse with respect to many other characteristics and sociopolitical locations across the globe and may thus experience a wide array of health journeys both individually and as partners in intimate relationships. In this review article, we summarize the major contributions of and ongoing gaps in existing studies about such couples’ experiences of chronic disease management in later life."
Author: Nowakowski ACH, Chan AY, Miller JF, Sumerau JE.
Publication: Gerontology and Geriatric Medicine. 2019;5.
Date: 15 Jan 2019
DOI: 10.1177/2333721418822865
Coming Out and Coming In to Living with Dementia: Enhancing Support for 2SLGBTQI People Living with Dementia and their Primary Unpaid Carers
🍁📑 Direct Link
"Through 2020-2022 Egale partnered with the National Institute on Ageing (NIA) to conduct research focused on better understanding the experiences and perspectives of 2SLGBTQI people living with dementia and primary unpaid carers* for 2SLGBTQI people living with dementia in Canada. The report discusses the significance of gender and sexual identity in experiences of living with dementia and providing care, the many ways that people become carers for 2SLGBTQI PLWD, and key needs, gaps, and strategies to mobilize networks of support. This discussion is relevant to the aging population, equity and healthcare access, and care work in Canada. Rooted in the research findings, the report provides specific action-oriented recommendations to build and enhance programming, policy, advocacy, and research. The report was co-authored by Dr. Ashley Flanagan and Dr. Celeste Pang."
💬 À l'intersection des identités 2SLGBTQI et des troubles neurocognitifs : renforcer les mesures de soutien pour les personnes 2SLGBTQI ayant un trouble neurocognitif et leur principal.e proche aidant.e non rémunéré.e
🍁💬📑 Telecharger Rapport
💬 "De 2020 à 2022, Egale s'est associée avec le National Institute on Ageing (NIA) afin de mener à bien une recherche visant à mieux comprendre les expériences et les points de vue des personnes-2SLGBTQI ayant un trouble neurocognitif et de leur principale personne proche aidante non rémunérée au Canada. Le rapport parle de l'importance des identités sexuelles et de genre dans le cadre des troubles neurocognitifs et des soins associés, des façons multiples et variées dont on devient la personne proche aidantes d'une personne-2SLGBTQI ayant un trouble neurocognitif, et des besoins, lacunes et stratégies clés pour mobiliser des réseaux de soutien. Cette discussion est pertinente au regard du vieillissement de la population, de l'équité et de l'accès aux soins de santé, et des prestations de soins au Canada. À partir des conclusions de la recherche, ce rapport fournit des recommandations concrètes en matière de programmation, de politique, de défense des intérêts et de recherche. Ce rapport a été coécrit par Ashley Flanagan, PhD, et Celeste Pang, PhD."
Cognitive Function Research
Transgender and gender diverse older people: Health, aging and dementia
📑 Direct Link 🔓 Open Access
"Older TGD adults face many barriers when accessing health and social care including experiences of discrimination, gatekeeping by healthcare professionals and limited access to services. These barriers impact on health outcomes in this population and their interactions with the health and social care system. There are high reported rates of poor physical and mental health, including HIV, mental illness and issues associated with gender-affirming treatment. Older TGD people are also reported to be at an increased risk of dementia, which is partly due to high incidences of dementia-associated risk factors. The epidemiology and experiences of older TGD people living with dementia are largely unknown due to limited research. However, the available literature suggests the current health and social care system is ill-equipped to manage their needs."
Author: Asti, E., Beale, N., Thorne, N., & Dening, T.
Publication: International Journal of Transgender Health, 27(1), 27–57.
Date: 21 May 2024
DOI: 10.1080/26895269.2024.2355232
Cognitive functioning in older transgender individuals receiving long-term gender-affirming hormone therapy
📑 Direct Link 🔓 Open Access
"Small cognitive differences between transgender men and cisgender groups do not suggest adverse or beneficial long-term testosterone effects on cognitive functioning. However, transgender women had lower cognitive functioning than cisgender groups, which was largely explained by mental/social health. This warrants further research and clinical awareness of mental and cognitive health in older transgender individuals."
Author: van Heesewijk, J. O., Dreijerink, K. M. A., Wiepjes, C. M., Kok, A. A. L., Geurtsen, G. J., van Schoor, N. M., … Kreukels, B. P. C.
Publication: International Journal of Transgender Health, 26(1), 88–104.
Date: 13 Dec 2023
DOI: 10.1080/26895269.2023.2289069
Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared with Cisgender Women and Men
📑 Direct Link 🔓 Open Access
"As one of the first studies, this study compared older transgender women to a large cohort of cisgender men and women regarding cognitive functioning and took into account numerous potential influencing factors. Limitations include difference in test procedures and the cross-sectional design of the study."
"CONCLUSION: Cognitive differences between transgender women and cisgender women and men were small, albeit significant. This may suggest that long-term GHT effects on cognitive functioning in older transgender women are minimal."
Author: Jason O. van Heesewijk, BSc, Koen M.A. Dreijerink, MD, PhD, Chantal M. Wiepjes, MD, PhD, Almar A.L. Kok, PhD, Natasja M. van Schoor, PhD, Martijn Huisman, PhD, Martin den Heijer, MD, PhD, Baudewijntje P.C. Kreukels, PhD
Publication: The Journal of Sexual Medicine, Volume 18, Issue 8, August 2021, Pages 1434–1443,
Date: 8 July 2021
DOI: 10.1016/j.jsxm.2021.05.013
Menopause
Queer / LGBTQIA+ Menopause
"The Queer Menopause MISSION is: To raise awareness of LGBTQIA+ experiences of menopause. To find and promote inclusive menopause resources. To push for better education for therapists and healthcare practitioners about the needs of LGBTQIA+ people in menopause." Instagram
LaSara Firefox Allen, MSW: The Genderqueer Menopause Coach
📖 Genderqueer Menopause
"The process of discomfort, discovery, and learning that my menopause experience required has led to my ongoing dedication toward creating a Menopause Coaching practice that is empowering and gender affirming. As The Genderqueer Menopause Coach, I am committed to offering unwavering support and guidance to genderqueer folx during their menopause transition. My mission is to provide a safe, inclusive, and affirming space where queer-bodied individuals can find the tools they need to navigate this potentially challenging and reliably complex phase of life."
🍁 Script What trans people need to know about menopause
"In Canada, more than 10 million cis women are of menopausal age—about one-quarter of the population, according to Statistics Canada. And while society has framed menopause as a life milestone that only affects cis women, it also impacts the lives of trans people, both those who medically transition and those who don’t.
So what do you need to know about menopause if you take gender-affirming hormone therapy (GAHT)? Script spoke to Dr. Elijah Salzer, a physician’s assistant and clinical professor at Pace University with a specialty in obstetrics and gynecology to break down what trans people can expect from menopause."
🍁💬 Ce que les personnes trans doivent savoir sur la ménopause
💬 "Au Canada, plus de dix millions de femmes cisgenre ont atteint l’âge de la ménopause, ce qui représente environ un quart de la population, selon les données de Statistique Canada. Bien que la ménopause soit socialement perçue comme une période charnière vécue uniquement par les femmes cis, elle affecte également la vie des personnes trans, qu’elles aient ou non entrepris une transition médicale. Alors, que faut-il savoir sur la ménopause lorsqu’on suit un traitement hormonal d’affirmation du genre (THAG)? Nous en avons discuté avec le docteur Elijah Salzer, assistant médical et professeur clinicien à l’université Pace, spécialiste en obstétrique et en gynécologie, pour mieux comprendre ce à quoi les personnes trans peuvent s’attendre durant la ménopause."
Menopause Research
“Because I felt so alone”: trans and gender diverse people’s needs and preferences for menopausal related information and resources
📑 Direct Link 🔓 Open Access
"Trans and gender diverse people require factual and practical information to i. diagnose themselves as being peri/menopausal and thus understand what was happening to them, ii. to know what therapeutic interventions were available if needed, and/or iii. to be able to manage their own health in ways that reflected their gender identity. Yet, they continue to struggle finding language, clinical guidance, or supportive care environments that acknowledge their experiences. Mainstream menopause resources may compound disparities for trans and gender diverse people through gender-exclusive language, cisnormative imagery, and limited acknowledgement of diverse hormonal trajectories."
Author: Drysdale, K., Karasu, Y., & Watson, L.
Publication: International Journal of Transgender Health, 1–14
Date: 22 Jan 2026
DOI: 10.1080/26895269.2026.2618635
Experiences of menopause among non-binary and trans people
📑 Direct Link 🔓 Open Access
"Whether TGNB people are taking hormonal interventions or not, it is also likely that psychosocial experiences of menopause would be different for gender-divergent individuals compared to their cis counterparts. Understandings of menopause as a specifically female experience, and one that is closely tied to reproductive capacity, might well have a different personal and social significance for TGNB individuals, depending on their experiences and identities around such matters. At present, however, there is little formal documentation of such issues. Understandings of menopause and age-related hormonal change that are framed around the needs of cisgender people may also create challenges in understanding and meeting TGNB people’s needs within health services. Clinical definitions that define menopause in terms of a ‘final’ menstrual period, loss of ovarian function or loss of fertility may be ambiguous in TGNB populations, given the impact of any prior hormonal and/or surgical intervention, and assigned sex at birth."
Author: Toze, M., & Westwood, S.
Publication: International Journal of Transgender Health, 26(2), 447–458.
Date: 10 Aug 2024
DOI: 10.1080/26895269.2024.2389924
Transgender health and the impact of aging and menopause
📑 Direct Link 🔓 Open Access
"Menopause is less relevant for transgender individuals who take GAHT (often given lifelong) to achieve sex steroid concentrations generally in the range of the affirmed gender. For people using feminizing hormone therapy, there is an elevated risk of venous thromboembolism, myocardial infarction, stroke and osteoporosis relative to cisgender individuals. For trans people using masculinizing hormone therapy, there is an increased risk of polycythemia, probable higher risk of myocardial infarction and pelvic pain which is poorly understood. Proactive mitigation of cardiovascular risk factors is important for all transgender people and optimization of bone health is important for those using feminizing hormones. With a lack of research to guide GAHT in older age, a shared decision-making approach is recommended for the provision of GAHT to achieve individual goals whilst minimizing potential adverse effects."
"For trans people who take GAHT, whether it be testosterone or estradiol, there remain minimal data on how to manage GAHT with aging, whether there are higher risks with commencement in older age or whether the dose needs to be reduced over time. There is no age at which GAHT is absolutely contraindicated, and in fact, trans people who commence GAHT in older age report higher quality of life scores compared to younger individuals."
Author: Cheung, A. S., Nolan, B. J., & Zwickl, S.
Publication: Climacteric, 26(3), 256–262.
Date: 03 Apr 2023
DOI: 10.1080/13697137.2023.2176217
Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care
📑 Direct Link
"Numerous studies have shown that adding testosterone to hormonal therapy can improve sexual function and general wellbeing among women during their menopause. A recent systematic review and meta-analysis of testosterone treatment in women has provided robust support for a trial of testosterone in women when clinically indicated. In postmenopausal women, testosterone supplementation improved several domains of sexual response, including sexual desire, pleasure, arousal, orgasm, and self-image. It has also been shown to have additional benefits including the improvement of urogenital, psychological, and somatic symptoms, an increase in bone density, and enhancement of cognitive performance when combined with oestrogen as part of HRT. Many women notice that taking testosterone improves their mood, concentration, motivation, and energy levels."
Author: Alice Scott & Louise Newson
Published by: The British Journal of General Practice
Date: 25 March 2020
DOI: 10.3399/bjgp20X709265
The information provided here covers Gender Affirming Surgery as a broader topic. For information about specific procedures, see their corresponding Care section above.
Research
A critical assessment of online patient education materials for gender-affirming surgery: a systematic review and meta-analysis Journal Link
"The objective of this study is to evaluate the readability, quality, and accessibility of online patient education materials related to gender-affirming surgeries." "Most OPEMs for gender-affirming care fail to meet health literacy guidelines, limiting accessibility. To improve patient comprehension, materials should be simplified without sacrificing accuracy, incorporate multimedia tools, and undergo usability testing. Standardized, trans-affirming, and linguistically inclusive resources are essential for equitable access and informed decision-making."
Author: Antoinette T Nguyen, BA, Rena A Li, BA, Robert D Galiano, MD, FACS
Publication: The Journal of Sexual Medicine, Volume 22, Issue 5, May 2025, Pages 951–960
Date: 10 April 2025
DOI: 10.1093/jsxmed/qdaf075
Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Antidepressant Use in Patients with Gender Dysphoria
📑 Direct Link 🔓 Free Access
"A total of 3134 patients with gender dysphoria were included in each cohort. Patients in the surgery group had overall lower rates of mental health conditions, substance misuse, and selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor use. There was an absolute decrease of 8.8% in selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor prescription after gender-affirming plastic surgery (P < 0.001), and significant decreases were found in postoperative depression (7.7%), anxiety (1.6%), suicidal ideation (5.2%) and attempts (2.3%), alcohol misuse (2.1%), and drug misuse (1.9%)."
Author: Kilmer, Lee H. MD; Chou, Jesse MD; Campbell, Christopher A. MD; DeGeorge, Brent R. MD, PhD; Stranix, John T. MD
Publication: Plastic and Reconstructive Surgery 154(5):p 1142-1149, November 2024
Date: 25 Jan 2024
DOI: 10.1097/PRS.0000000000011325
Gender dysphoria: Quality of online information for gender reassignment surgery
📑 Direct Link 🔓 Free Access
"The quality of information provided by the Web regarding gender reassignment surgery was not satisfactory. Healthcare portals and hospitals reported a lower score than practitioners’ websites, conversely achieving the best scores. This difference may be because this surgery is performed only in highly specialised centres and such procedures are not commonly performed. As a result of our observations, we believe that the Internet should not be used as the main source of medical information, and physicians should maintain the role model, walking these patients through the intricacies of gender reassignment surgery. Therefore, the information on the Web has to be well-planned and reviewed by specialists. Reliable data, expressed through clear language, must be reported on online pages. Complications should be cited to provide complete knowledge. Only this way can it be possible to supply good quality information on the Web to support patients’ decisions and the correct Internet use."
Author: Lo Torto F, Mori FR, Bruno E, Giacomini G, Turriziani G, Firmani G, Marcasciano M, Ribuffo D.
Publication: JPRAS Open. 2023 Sep 1;38:117-123
Date: 27 Aug 2023
DOI: 10.1016/j.jpra.2023.08.008
Gender Affirming Surgery: A Comprehensive, Systematic Review of All Peer-reviewed Literature and Methods of Assessing Patient-centered Outcomes (Part 1: Breast/Chest, Face, and Voice) Journal Link
"Objective: To perform the first systematic review of all available gender-affirming surgery (GAS) publications across all procedures to assess both outcomes reported in the literature and the methods used for outcome assessment.
Summary of Background Data: Rapidly increasing clinical volumes of gender-affirming surgeries have stimulated a growing need for high-quality clinical research. Although some procedures have been performed for decades, each individual procedure has limited data, necessitating synthesis of the entire literature to understand current knowledge and guide future research."
Author: Oles, Norah BS; Darrach, Halley MD; Landford, Wilmina MD; Garza, Matthew BS; Twose, Claire MLIS; Park, Chanjun S. BS; Tran, Phuong MS; Schechter, Loren S. MD; Lau, Brandyn MPH; Coon, Devin MD, MSE, FACS
Publication: Annals of Surgery 275(1):p e52-e66, January 2022
Date: Jan 2022
DOI: 10.1097/SLA.0000000000004728
Gender Affirming Surgery: A Comprehensive, Systematic Review of All Peer-reviewed Literature and Methods of Assessing Patient-centered Outcomes (Part 2: Genital Reconstruction) Journal Link
"Assessment of GAS results is complex and multidimensional, involving not only complication rates but also anatomic (eg, vaginal depth), functional (eg, urinary), and psychosocial outcomes. A fully comprehensive aggregation of all prior research would offer an essential cornerstone for continued progress."
Author: Oles, Norah BS; Darrach, Halley MD; Landford, Wilmina MD; Garza, Matthew BS; Twose, Claire MLIS; Park, Chanjun S. BS; Tran, Phuong MS; Schechter, Loren S. MD; Lau, Brandyn MPH; Coon, Devin MD, MSE, FACS
Publication: Annals of Surgery 275(1):p e67-e74, January 2022
Date: Jan 2022
DOI: 10.1097/SLA.0000000000004717
🍁 Queering Cancer
"Inclusive and equitable healthcare requires all patients to feel safe and be seen. We are Canada’s only national organisation dedicated to supporting sexual and gender diverse people affected by cancer."
Rainbow Health Ontario
🍁📑 Health In Focus: 2SLGBTQ+ Cancer Disparities and Barriers to Care
"This educational resource highlights the health care, social service and cancer care needs of 2SLGBTQ+ people. It helps healthcare providers identify systemic barriers in cancer care access while offering practical strategies to create more affirming, inclusive care environments for this population."
🍁 Queer + Trans Health Collective: Cancer Screening
"Below, we’ve included some information about screening for 2S/LGBTQIA+ populations as it relates to a variety of cancers. It’s important to recognize that this is not an exhaustive list of cancers or related screening. Speak with a health care professional about your options if you ever feel as though you are at risk. Note: It’s important to note that screening programs may vary between provinces (for example, age ranges for when certain tests might be recommended or publicly covered may differ)"
🍁 Canadian Cancer Society Screening in 2SLGBTQI+ communities
"Like everybody else, Two-Spirit, lesbian, gay, bisexual, trans, queer or questioning, and intersex (2SLGBTQI+) people and others who identify as part of 2SLGBTQI+ communities should be screened for cancer. 2SLGBTQI+ people are less likely to get screened for breast, cervical and colorectal cancer than cisgender and heterosexual people. This means that 2SLGBTQI+ people may have a higher risk of dying from these cancers. It may be difficult for members of 2SLGBTQI+ communities to find health information that speaks to them. A major barrier to getting screened is that some healthcare settings aren’t inclusive or welcoming. 2SLGBTQI+ people are less likely to have a primary healthcare provider and more likely to delay seeking medical care or screening because of actual or perceived discrimination."
🍁💬 Société canadienne du cancer Dépistage dans les communautés 2ELGBTQI+
💬 "Comme tout le monde, les personnes aux deux esprits, lesbiennes, gaies, bisexuelles, trans, queers ou en questionnement, et intersexuées (2ELGBTQI+), de même que les autres personnes qui s’identifient aux communautés 2ELGBTQI+, devraient passer des tests de dépistage du cancer. Les personnes 2ELGBTQI+ sont moins enclines à passer des tests de dépistage du cancer du sein, du cancer du col de l’utérus et du cancer colorectal que les personnes cisgenres et hétérosexuelles. Cela signifie que le risque de décéder de ces cancers est plus élevé chez les personnes 2ELGBTQI+. Il peut être difficile pour les membres des communautés 2ELGBTQI+ de trouver de l’information sur la santé qui leur correspond. Le fait que certains environnements de soins de santé ne sont pas inclusifs ou accueillants peut constituer un obstacle majeur au dépistage. Il est moins probable que les personnes 2ELGBTQI+ aient un professionnel de la santé offrant des soins primaires et plus probable qu’elles tardent à obtenir des soins médicaux ou un dépistage en raison de la discrimination réelle ou perçue."
Cedars-Sinai Gender Affirming Cancer Screening
"For transgender patients, hormone therapy doesn't necessarily carry the same risks because they often do not have the organs that are linked to increased chances of developing cancer when taking those hormones. Transgender women who have undergone hormone therapy do carry a slightly higher risk of breast cancer than non-transgender men, but their risk is lower than non-transgender women. Transgender men on testosterone therapy are carefully monitored. If they're taking a high amount of the hormone—more than the body can use—it can chemically change and affect the uterus in the same way too much estrogen might. However, these cases are rare. Cancer complications arising from hormone therapy for transgender patients is an area that is ripe for scientific study, as there are few available studies."
LGBTQ+ Guide for Cancer Screening
"This website is a project of the Cancer Research Center for Health Equity at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai."
"The recommendations on this website are based on guidelines by the American Cancer Society. We customize the recommendations for our LGBTQ+ community using your answers in the Create Your Guide section of this website."
The Cancer Network
"We are committed to advancing health equity by supporting LGBTQIA+ people, caregivers, and providers navigating cancer."
"The mission of The Cancer Network is to improve the lives of LGBTQIA+ cancer survivors and those at risk by: EDUCATING the LGBTQIA+ community about our increased cancer risks and the importance of screening and early detection. TRAINING health care providers to offer more culturally-competent, safe and welcoming care. ADVOCATING for LGBTQIA+ survivors in mainstream cancer organizations, the media and research."
Gynecologic Oncology Needs for Trans-Masculine and Trans Feminine Persons
📑 Direct Link 🔓 Open Access
"This article will discuss the current strategies for gender inclusive gynecologic cancer screening of the cervix, consideration of HPV related dysplasia of the neovagina, discussion of the role of abnormal uterine bleeding in the presentation of endometrial cancer in the transmasculine person, and lastly, discuss the current data regarding androgen receptors and ovarian cancer risk and considerations for treatment. This is not an exhaustive list of the needs of transgendered persons seeking gynecologic oncology care but endeavors to be a set of frequently encountered clinical situations where data is emerging."
Author: Rimel, B.J., Murphy, L.
Publication: Curr Obstet Gynecol Rep 13, 154–159 (2024).
Date: 17 May 2024
DOI: 10.1007/s13669-024-00386-x
Cancer in Transgender and Gender-Diverse Persons: A Review Journal Link
"This review revealed that transgender and gender-diverse people had a high prevalence of tobacco consumption and alcohol use and high rates of infection with human papillomavirus (HPV) and HIV. Transgender and gender-diverse individuals were less likely to adhere to cancer screening programs and had a higher incidence of HIV- and HPV-associated cancers. Social and economic determinants seemed to drive these disparities in risk factors and outcomes. A lack of knowledge about gender minorities’ health needs among health care practitioners was evidenced, and it represented a major hurdle to cancer prevention, care, and survivorship for transgender and gender-diverse individuals."
Author: Alberto Giovanni Leone, MD; Dario Trapani, MD2; Matthew B. Schabath, PhD et al
Publication: JAMA Oncology 2023;9;(4):556-563
Date: 9 Feb 2023
DOI: 10.1001/jamaoncol.2022.7173
Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model
📑 Direct Link 🔓 Open Access
"The aim of this review is to cover current guidelines and practice patterns of cancer screening in transgender patients, and, where evidence-based data is lacking, to draw from cis-gender screening guidelines to suggest best-practice screening approaches for transgender patients."
Author: Joshua Sterling, Maurice M. Garcia
Publication: Transl Androl Urol Vol 9, No 6 (December 27, 2020)
Date: 4 Sep 2020
DOI: 10.21037/tau-20-954
🍁 Canadian Cancer Society As a trans woman or non-binary person assigned male at birth, do I need to get screened for breast cancer?
"If you are taking estrogen as part of your gender-affirming care, you may develop breasts. If you have taken estrogen for at least 5 years in total, you should be screened for breast cancer once you reach a certain age. If you are 40 to 74 years old, have a mammogram every 2 years. If you are 75 or older, talk to your healthcare provider about whether having a mammogram is right for you. If you have never taken estrogen or have taken estrogen for less than 5 years in total, you do not need breast cancer screening. But knowing your body is still important. Get to know how your breasts or chest area looks and feels and tell your healthcare provider about any changes."
As a trans man or non-binary person assigned female at birth, do I need to get screened for breast cancer?
"If you haven’t had any chest surgery, or if you’ve had a chest reduction, you should be screened for breast cancer once you reach a certain age, even if you are taking testosterone. If you are 40 to 74 years old, have a mammogram every 2 years. If you are 75 or older, talk to your healthcare provider about whether having a mammogram is right for you." "Researchers are still trying to determine the best way to screen for breast cancer in trans men and non-binary and gender-diverse people who have had a mastectomy (surgery to remove all of the breast) as part of gender-affirming care. If you have had a mastectomy, it can be harder to screen for breast cancer with a mammogram. More research is needed on other screening approaches like MRI or ultrasound to make an evidence-informed recommendation. Some breast tissue is still left after surgery, so knowing your body is important."
🍁💬 Société canadienne du cancer En tant que femme trans ou personne non binaire à qui on a assigné le sexe masculin à la naissance, ai-je besoin de passer un test de dépistage du cancer du sein?
💬 "Si vous prenez de l’œstrogène dans le cadre de vos soins d’affirmation de genre, vous pourriez avoir des seins. Si vous avez pris de l’œstrogène pendant au moins cinq ans en tout, vous devriez passer un test de dépistage du cancer du sein lorsque vous atteignez un certain âge. Si vous avez entre 40 et 74 ans, passez une mammographie tous les deux ans. Si vous avez 75 ans ou plus, demandez à votre professionnel de la santé si vous devez passer une mammographie. Si vous n’avez jamais pris d’œstrogène ou en avez pris pendant moins de cinq ans en tout, vous n’avez pas besoin de passer de test de dépistage du cancer du sein. Mais il est toujours important de connaître son corps. Apprenez à connaître l’apparence et la texture de vos seins ou de votre poitrine et signalez tout changement à votre professionnel de la santé."
En tant qu’homme trans ou personne non binaire à qui on a assigné le sexe féminin à la naissance, ai-je besoin de passer un test de dépistage du cancer du sein?
💬 "Si vous n’avez pas eu de chirurgie à la poitrine, ou si vous avez subi une réduction mammaire, vous devriez passer un test de dépistage du cancer du sein lorsque vous atteignez un certain âge, même si vous prenez de la testostérone. Si vous avez entre 40 et 74 ans, passez une mammographie tous les deux ans. Si vous avez 75 ans ou plus, demandez à votre professionnel de la santé si vous devez passer une mammographie." "Pour trouver la méthode de dépistage qui vous convient, parlez avec votre professionnel de la santé. Cette personne pourrait effectuer un examen physique de la poitrine et des ganglions de l’aisselle pour vérifier s’il y a des bosses, des zones dures ou sensibles ou une douleur dans cette région-là. Les chercheurs essaient toujours de déterminer la meilleure méthode de dépistage du cancer du sein chez les hommes trans et les personnes non binaires et de diverses identités de genre qui ont subi une mastectomie (opération pour enlever le sein au complet) dans le cadre des soins d’affirmation de genre. Si vous avez subi une mastectomie, il pourrait être plus difficile de passer une mammographie pour détecter le cancer du sein. Il faudrait effectuer plus de recherches sur les autres méthodes de dépistage comme l’IRM ou l’échographie pour faire une recommandation fondée sur des données probantes. Il reste du tissu mammaire après la chirurgie, donc il est important de connaître son corps."
Cedars-Sinai Breast Cancer Has No Gender
"When it comes to cancer risk, an open dialogue between patients of all genders and their healthcare providers is essential. "Everyone has breast tissue," says Edward Ray, MD, a surgeon in the Breast Cancer Program and Transgender Surgery and Health Program at Cedars-Sinai. "We shouldn't be afraid to talk about breast health with any patient.""
Gender Affirming Care at UC San Francisco General approach to cancer screening in transgender people
"Primary care providers should conduct an organ based routine cancer screening for all transgender patients in accordance with current guidelines as a component of comprehensive primary care. As a rule, if an individual has a particular body part or organ and otherwise meets criteria for screening based on risk factors or symptoms, screening should proceed regardless of hormone use."
Screening for breast cancer in transgender women
"In transgender women, factors that may contribute to a reduced risk of breast cancer include potentially less lifetime overall or cyclical exposure to estrogen and in some cases the absence of or minimal exposure to progesterone. However, transgender women have a high prevalence of dense breasts, an independent risk for breast cancer and also a predictor of increased rates of false negative mammograms; a Dutch study of 50 transgender women found that 60% had "dense" or "very dense" breasts on mammography."
Breast cancer screening in transgender men
"Transgender men who have not undergone bilateral mastectomy, or who have only undergone breast reduction, should undergo screening according to current guidelines for non-transgender women. No reliable evidence exists to guide the screening of transgender men who have undergone mastectomy. Since most or nearly all breast tissue may have been removed, mammography for the evaluation of a palpable lesion may not be technically feasible, and alternatives such as ultrasound or MRI may be necessary."
Living Beyond Breast Cancer Breast Cancer and Transgender People
"We don’t know how many people who identify as transgender are living with breast cancer. One of the reasons for this is that historically, cancer registries haven’t collected this information. However, this is changing: National organizations such as the American Society of Clinical Oncology (ASCO) and the American Association of Cancer Research (AACR) have been advocating to collect this data."
Breast Cancer Screening Recommendations for Transgender People
"Still, there are now more resources for transgender people than there have been in the past. In fact, the American College of Radiology (ACR) offers breast cancer screening guidelines for transgender people based on age; sex (female or male) assigned at birth; risk factors; and use of hormone therapy, surgery, or both that may be used in the transitioning process. Based on these guidelines, it is important to talk to your doctor about when and how often to get screened."
American College of Radiology: ACR Appropriateness Criteria® Transgender Breast Cancer Screening
"The incidence of breast cancer in the transgender community is largely unknown because of inadequate epidemiological information and a lack of longitudinal studies. Current evidence consists primarily of case reports and several cohort studies, all of which are retrospective. However, a younger age at the time of breast cancer diagnosis has been reported in transgender people [1-5]. Gender-affirming therapy can influence an individual’s risk of developing certain cancers, including breast cancer [5,6]. Transgender patients may undergo either gender-affirming hormone treatment (previously known as cross-sex hormone treatment), surgical treatment, or a combination thereof as part of their transition. Updated clinical practice guidelines from the Endocrine Society allow earlier medical intervention for transgender youth beginning with pubertal hormone suppression once children first exhibit changes of puberty (Tanner stage 2) [7]."
📑 Direct Link
🍁Script Trans people need breast cancer screenings, too
"Studies show it takes queer and trans people almost twice as long to be diagnosed with breast and chest cancer as straight cis folks. “Delayed diagnosis most likely leads to more aggressive treatments like chemotherapy and lymph node dissection and worse outcomes,” says Dr. Robyn G. Roth, a board-certified radiologist in New Jersey who specializes in breast imaging. The research found that 38 percent of LGBTQ2S+ folks refused traditional treatment."
🍁💬 Cancer du sein: un dépistage essentiel, mais difficile d’accès pour les personnes trans
💬 "Les recherches montrent que chez les personnes queer ou trans, se faire diagnostiquer un cancer de la poitrine ou du sein prend presque deux fois plus longtemps que chez les hétéros cisgenres. « Plus le diagnostic est tardif, plus on doit recourir à des traitements agressifs comme la chimiothérapie ou le curage ganglionnaire, et moins le pronostic est bon », explique la docteure Robyn G. Roth, une radiologue spécialisée dans l’imagerie du sein qui pratique au New Jersey. Or, la recherche montre que 38% des personnes LGBTQ2S+ ont déjà refusé un traitement conventionnel."
Breast Cancer Research
Disparities in Study Inclusion and Breast Cancer Screening Rates Among Transgender People: A Systematic Review Journal Link
"Breast cancer screening trends of transgender and gender diverse (TGD) people remain largely unknown. This is concerning, as data are necessary to inform recommendations made by clinicians to their patients and by national guidelines to clinicians. The aim of this review is to explore the state of existing research literature and provide a summary report of current breast cancer screening rates in TGD adults."
📑 Visual Abstract
Author: Chokshi M, Morgan O, Carroll E et al.
Publication: Journal of the American College of Radiology Volume 21, Issue 9, September 2024, Pages 1430-1443
Date: 24 April 2024
DOI: 10.1038/s41416-022-01989-y
Aspects to consider regarding breast cancer risk in trans men: A systematic review and risk management approach
📑 Direct Link 🔓 Open Access
"PubMed was systematically searched on the 14th of March 2023 to find all published cases of breast cancer following chest contouring surgery in trans men. Included articles had to involve trans men, the diagnosis of breast cancer had to be preceded by either a medical or surgical intervention related to gender dysphoria, and cases needed to involve invasive breast cancer or ductal carcinoma in situ. Articles were excluded if gender identity in the case subject was unclear and/or a full English version of the report was unavailable. Quality and risk of bias was evaluated using the GRADE protocol. A literature review of specific risk altering aspects in this population followed. The Swiss cheese model was employed to present a risk analysis and to propose ways of managing this risk."
Author: Wahlström E, Audisio RA, Selvaggi G
Publication: PLOS ONE 19(3): e0299333
Date: 7 March 2024
DOI: 10.1371/journal.pone.0299333
Breast and Cervical Cancer Screening Disparities in Transgender People Journal Link
"Compared with the CG population, TG participants were less likely to adhere to or have undergone breast screening. They were also less likely to have a primary care physician and less likely to seek primary care within a year owing to medical costs."
Author: Oluwadamilola T. Oladeru, Sung Jun Ma, Joseph A. Miccio, et al
Publication: American Journal of Clinical Oncology: Cancer Clinical Trials, 45(3):p 116-121, March 2022.
Date: 1 Feb 2022
DOI: 10.1097/COC.0000000000000893
Transfeminine Resources
🍁 Canadian Cancer Society As a trans woman or non-binary person assigned male at birth, do I need to get tested for prostate cancer?
"If you have a prostate, you should make an informed decision about whether the prostate-specific antigen (PSA ) test is right for you by talking to your healthcare provider about the benefits and limitations of testing, your personal risk, your values and preferences, and what other procedures may follow." "If you are taking estrogen, your PSA levels may be lower, so some experts suggest that a lower cut-off level of 1.0 ng/mL should be used to determine if you have a higher than normal PSA level."
🍁💬 Société canadienne du cancer En tant que femme trans ou personne non binaire à qui on a assigné le sexe masculin à la naissance, ai-je besoin de passer un test de dépistage du cancer de la prostate?
💬 "Si vous avez une prostate, vous devriez décider de façon éclairée si le test de l’antigène prostatique spécifique (APS) vous convient en discutant avec votre professionnel de la santé des avantages et des limites des tests de dépistage, de votre risque personnel, de vos valeurs et préférences et des autres interventions qui pourraient suivre." "Si vous prenez de l’œstrogène, votre taux d’APS peut être plus faible; certains experts suggèrent donc d’abaisser le seuil à 1,0 ng/mL pour déterminer si votre taux d’APS est plus élevé que la normale."
Prostate Cancer UK Trans Women and Prostate Cancer
"The information on this page is based on research about trans women. But some of it will be relevant to non-binary and intersex people who’ve had gender affirming surgery or taken feminising hormones."
Prostate Cancer Diagnosis in Trans Women
"This page describes the steps to getting a diagnosis if you’re a trans woman, non-binary person assigned male at birth, or an intersex person who has a prostate. We explain how you can get a prostate specific antigen (PSA) blood test and what your test results might mean. We also go through what to expect if you have a prostate examination, and what tests you might have at the hospital."
Prostate Cancer Treatments For Trans Women
"Your treatment will depend on your cancer stage. Read about what can affect your prostate cancer treatment options. If you’re a trans woman, your medical transition can also affect your treatment options. For example, some treatments are not advised before gender affirming surgery, and others are not advised after gender affirming surgery. It’s up to you how much of your trans history you share, but telling your doctor about any hormones or surgery you’ve had can help them find the right treatment for you."
Gender Affirming Care at UC San Francisco Prostate and testicular cancer considerations in transgender women
"Regardless, primary care providers should remain aware of the possibility of prostate cancer in transgender women, even those who have undergone gonadectomy. The decision to perform screening for prostate cancer in transgender women should be made based on guidelines for non-transgender men. If a prostate exam is indicated, both rectal and neovaginal approaches may be considered. Transgender women who have undergone vaginoplasty have a prostate anterior to the vaginal wall, and a digital neovaginal exam examination may be more effective. It should be noted that when PSA testing is performed in transgender women with low testosterone levels, it may be appropriate to reduce the upper limit of normal to 1.0 ng/ml."
"Routine testicular cancer screening is not recommended in non-transgender men, and there is no evidence to perform screening in transgender women. Transgender women adherent to therapeutic doses of estrogen plus an androgen blocker, and with persistent testosterone elevations, should be evaluated for testicular tumors by physical exam, as well as human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and lactic dehydrogenase (LDH) levels, and possibly a scrotal ultrasound."
Transfeminine Research
🍁 Prostate-specific antigen screening among transgender women in clinical care: A retrospective chart review study
📑 Direct Link 🔓 Open Access
🍁 "Prostate-specific antigen (PSA) screening is controversial due to over-detection and treatment of low-grade prostate cancer. Consequently, the Canadian Urological Association (CUA) and the Canadian Task Force on Preventive Health Care (CTFPHC) differ with respect to recommending for versus recommending against PSA screening. Regardless, Canadian and global guidelines recommending PSA screening fail to address transgender (trans) women/transfeminine persons, though studies suggest this population remains at risk of prostate cancer, particularly those who have not accessed gender-affirming hormone therapy (GAHT) or gender-affirming surgeries. The objectives of this study were to: (1) characterize the prevalence of trans women/transfeminine persons aged 50+ who have ever received PSA screening and (2) explore sociodemographic, clinical, and social/structural factors associated with ever receiving PSA screening."
Author: 🍁 Ashley Lacombe-Duncan, Gabi Celia Ortiz, Angela Underhill, Monica Brundage, Adrien Saucier, John Goodhew, Quang Nguyen, Mona Loutfy
Publication: Urologic Oncology: Seminars and Original Investigations Volume 43, Issue 11, November 2025, Pages 664.e1-664.e9
Date: Nov 2025
DOI: 10.1016/j.urolonc.2025.07.017
Prevalence and Factors Associated With Prostate Cancer Among Transgender Women Journal Link 🔓 Free Access
"Evidence on prostate cancer (PCa) in transgender women is very limited; data are needed to reduce gender disparities in both PCa knowledge and health care. The primary aim of this study was to evaluate the prevalence of PCa among transgender women in the US. The secondary objectives include identifying the factors associated with PCa in the transgender population, and determining the factors associated with biochemical recurrence (BCR) and bone metastases (BM) in transgender patients with PCa."
Author: Celeste Manfredi, MD; Antonio Franco, MD; Francesco Ditonno, MD et al
Publication: JAMA Oncology 2024;10;(12):1697-1700
Date: 3 Oct 2024
DOI: 10.1001/jamaoncol.2024.4335
Thyroid Cancer Prevalence, Risk Exposure, and Clinical Features Among Transgender Female Veterans Journal Link 🔓 Free Access
"To our knowledge, this study represents the first report of thyroid cancer prevalence among transgender women in the United States. Risk exposure among all transgender veterans including further assessment of the possible contributions of obesity, smoking, and gender-affirming hormone therapy are important future analyses."
Author: Christensen, John David et al.
Publication: Journal of the Endocrine Society vol. 8,6
Date: 27 March 2024
DOI: 10.1210/jendso/bvae060
Prostate Cancer in Transgender Women: Epidemiology, Clinical Characteristics, and Management Challenges Journal Link
"To systematically review the evidence on prostate cancer (PCa) in transgender women (TGW)." "Few cases of PCa in TGW are currently reported. PCa seems significantly less frequent in TGW than in cisgender males; however, some data suggest a possible higher mortality in this cohort. TGW appear to have less access to PSA testing than cisgender men."
Author: Manfredi, C., Ditonno, F., Franco, A. et al.
Publication: Epidemiology, Clinical Characteristics, and Management Challenges. Curr Oncol Rep 25, 1431–1443 (2023).
Date: 1 Nov 2023
DOI: 10.1007/s11912-023-01470-w
Prostate cancer in transgender women: considerations for screening, diagnosis and management Journal Link
"Due to limitations of existing cohort studies, the true incidence of prostate cancer in transgender females is unknown but is thought to be less than the incidence among cis-gender males. It is unclear how prostate cancer develops in androgen-deprived conditions in these patients. Six out of eleven case reports in the literature presented with metastatic disease. It is thought that androgen receptor-mediated mechanisms or tumour-promoting effects of oestrogen may be responsible." "In this review, we discuss the evidence surrounding screening and treatment of prostate cancer in transgender women and consider the current gaps in our knowledge in providing evidence-based guidance at the molecular, genomic and epidemiological level, for clinical decision-making in the management of these patients."
Author: Crowley, F., Mihalopoulos, M., Gaglani, S. et al.
Publication: Br J Cancer 128, 177–189 (2023).
Date: 19 Oct 2022
DOI: 10.1038/s41416-022-01989-y
Prostate cancer in transgender women: what does a urologist need to know?
📑 Direct Link 🔓 Free Access
"The risk of prostate cancer in transgender women who are not on gender-affirming hormone therapy (GAHT) or who have not had gender-affirming surgery (GAS) and gender non-conforming individuals (who may never commence GAHT or have GAS) is the same as that in the cis male population. In these patients, healthcare professionals need to be able to discuss screening, diagnostic and treatment options considering future wishes for gender-affirming treatment. Prostate cancer incidence in transgender women on GAHT or following GAS is lower than age-matched cis-male counterparts, but diagnosis and treatment is more nuanced. The present review discusses the existing literature about development and incidence of prostate cancer in this population, and makes recommendations about screening, the usefulness of diagnostic tools e.g. prostate-specific antigen and magnetic resonance imaging, and considerations when formulating treatment. Potential directions for future research are discussed, which will hopefully lead to development of robust evidence-based guidelines for the diagnosis and management of prostate cancer in transgender women."
Author: Bertoncelli Tanaka, M., Sahota, K., Burn, J., Falconer, A., Winkler, M., Ahmed, H.U., Rashid, T.G. and the Gender Research Collaborative
Publication: BJU Int, 129: 113-122.
Date: 22 June 2021
DOI: 10.1111/bju.15521
Transmasculine Resources
🍁 Canadian Cancer Society As a trans man or non-binary person assigned female at birth, do I need to get screened for cervical cancer?
"Anyone with a cervix can get cervical cancer. The cervix is at the top of the vagina. Some trans men may call the vagina the front hole. Almost all cervical cancer cases are due to HPV infection. HPV is spread through sexual contact including sexual intercourse, genital skin-to-skin contact and oral sex, regardless of gender or sexual orientation. If you are a trans man or non-binary person assigned female at birth, talk to your healthcare provider about screening." "If you have a cervix and have ever had sexual contact with anyone, regardless of gender or sexual orientation, you should start having regular Pap tests by the time you’re 25. You’ll need a Pap test every 3 years or as recommended by your healthcare provider, whether or not you’re taking testosterone. It’s important to tell your healthcare provider if you are taking testosterone because this can cause changes to cervical tissue that can affect your test results."
🍁💬 Société canadienne du cancer En tant qu’homme trans ou personne non binaire à qui on a assigné le sexe féminin à la naissance, ai-je besoin de passer un test de dépistage du cancer du col de l’utérus?
💬 "Toute personne qui a un col de l’utérus peut développer un cancer du col de l’utérus. Le col de l’utérus se trouve au-dessus du vagin. Certains hommes trans peuvent désigner le vagin comme étant le trou avant. Presque tous les cas de cancer du col de l’utérus sont attribuables à une infection par le VPH. Le VPH se propage par contact sexuel, ce qui inclut les relations sexuelles, le contact génital peau sur peau et les relations buccogénitales, et ce, peu importe le genre ou l’orientation sexuelle. Si vous êtes un homme trans ou une personne non binaire à qui on a assigné le sexe féminin à la naissance, discutez du dépistage avec votre professionnel de la santé." "Si vous avez un col de l’utérus et que vous avez déjà eu des contacts sexuels avec qui que ce soit, peu importe le genre ou l’orientation sexuelle, vous devriez commencer à passer des tests Pap régulièrement dès l’âge de 25 ans. Vous aurez besoin de passer un test Pap tous les trois ans ou à la fréquence recommandée par votre professionnel de la santé, que vous preniez ou non de la testostérone. Si vous en prenez, il est important de le mentionner à votre professionnel de la santé, car cela peut entraîner des modifications au tissu du col de l’utérus et avoir un effet sur les résultats de votre test."
Gender Affirming Care at UC San Francisco Ovarian and endometrial cancer considerations in transgender men
"As such, routine screening for endometrial cancer in transgender men using testosterone is not recommended. Unexplained vaginal bleeding (in the absence of missed or changed dosing of testosterone) in a patient previously with testosterone-induced amenorrhea should be explored." "From a primary care perspective, no effective screening algorithm is available for ovarian cancer screening in any individuals without a greater than average risk (i.e., known genetic or personal/family risk factors). Transgender men should receive the same recommended counseling and screenings for anyone with ovaries based on history and presentation."
Screening for cervical cancer in transgender men
"Cervical cancer screening should never be a requirement for testosterone therapy. Cervical cancer screening for transgender men, including interval of screening and age to begin and end screening follows recommendations for non-transgender women as endorsed by the American Cancer Society, American Society of Colposcopy and Cervical Pathology (ASCCP), American Society of Clinical Pathologists, U.S. Preventive Services Task Force (USPSTF) and the World Health Organization (Grading: X C S). As with non-transgender women, transgender men under the age of 21 should not have pap smears regardless of their age of sexual debut. Pap smears on transgender men have a ten-fold higher incidence of an unsatisfactory result compared to non-transgender women, which is positively correlated with length of time on testosterone."
Bridging Barriers to Cervical Cancer Screening in Transgender Men: A Scoping Review
📑 Direct Link 🔓 Open Access
"Estimates of high-risk human papillomavirus (HPV) infection and susceptibility to HPV-related cancer in transgender men (TM) are comparable to prevalence rates found in cisgender women. Regular and thorough screening for cervical cancer is equally as crucial for TM as for cisgender women; however, despite continued risk for cervical cancer in TM and associated recommendations for screening, studies indicate disparities in rates of cervical cancer screening (CCS) in TM compared to cisgender women. The current scoping review explores TM’s knowledge and experiences of CCS and barriers to screening uptake in this population. A range of barriers were identified including the need for health-care services to provide care for TM within the context of a nonbinary approach to gender identity and health."
Author: Dhillon N, Oliffe JL, Kelly MT, Krist J.
Publication: American Journal of Men’s Health. 2020;14(3).
Date: 3 June 2020
DOI: 10.1177/1557988320925691
Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening Journal Link
"The high unsatisfactory sample prevalence among FTM patients is likely due to a combination of physical changes induced by testosterone therapy and provider/patient discomfort with the exam. Clinicians should receive training in increasing comfort for FTM patients during the exam. FTM patients should be alerted that high rates of inadequate screening may require follow-up testing. Alternatives to repeated Pap testing, such as cytologic reprocessing of inadequate samples or primary human papillomavirus (HPV) DNA screening, should be studied for efficacy and acceptability among FTM patients."
Author: Peitzmeier, S.M., Reisner, S.L., Harigopal, P. et al.
Publication: Journal of Internal Medicine Volume 29, pages 778–784, (2014)
Date: 15 Jan 2014
DOI: 10.1177/1557988320925691
Resources
American Society of Hematology: Hematology and the Transgender Patient
"Many clinicians also may not be well-versed in the unique treatment considerations for this patient population, such as balancing the emotional benefits of hormone therapy with potential hematologic risks for transgender individuals taking these drugs or incorporating culturally sensitive practices into care settings. Some research has suggested that transgender women (those assigned male sex at birth who identify as female) have an increased thrombotic risk compared to cisgender women, a term used for those whose gender identity matches the female sex they were assigned at birth. Other research has found that transgender men – those who were assigned female sex at birth but identify as male – may have a greater prevalence of certain types of cancer than cisgender men. But, without clear protocols or standards of care, questions remain about optimal management of transgender patients. For example, if a transgender woman taking estrogen as part of her feminizing hormone therapy experiences a blood clot, how should anticoagulation be managed? If a transgender male develops erythrocytosis while taking testosterone, is that a risk factor for future health problems?"
Pulmonary Advisor: Cardiovascular Care for Transgender and Gender-Diverse Patients
"“There is emerging research to suggest that exogenous hormone therapy may not be the most significant driver of disparities in cardiovascular health” in TGD individuals, explained C Streed Jr, MD, MPH, associate professor of medicine in the section of general internal medicine at the Boston University Aram V Chobanian & Edward Avedisian School of Medicine and research director of the GenderCare Center at Boston Medical Center. “Consequently, we must consider additional pathways that account for disparities in outcomes for TGD people,” said Dr Streed, who co-authored a scientific statement from the American Heart Association (AHA) on managing cardiovascular health in LGBTQ+ adults. According to Dr Safer, “It may be that the biggest driver of greater disease burden in this population relates to social determinants of health, including access to health care.” In a study by Dr Safer and colleagues, they found that the main barrier to health care reported by TGD individuals was a lack of providers knowledgeable about TGD medicine."
The British Heart Foundation: Do transgender people have a higher risk of heart problems?
"There is some concern about a possible link between gender-affirming hormone therapy and the risk of heart and circulatory problems, including some evidence for a link with blood clots and dyslipidaemia (increased levels of fat in the blood). But there’s a lack of research in this area, and the research that does exist is often contradictory." "We know that trans people, whether or not they take hormones, are at higher risk of heart attacks and strokes. For example, a 2019 analysis using a large-scale survey of people in the USA found trans people had a higher reported history of heart attacks compared to cisgender people (people whose gender identity matches the biological sex they were born with), even after adjusting for other risk factors. Some of this is likely to be due to stigma and social factors. Dr Connelly explains that stigma and stress is common for trans people, and that this can also affect their cardiovascular health. Dr Connelly says: “Transgender people can persistently face stigma (both internalised and from others), and experience discrimination and violence, which create psychological distress.” When you are consistently facing stress and distress, and experiencing poor mental health, it’s very hard to make positive lifestyle changes, and that can increase your risk of developing heart and circulatory diseases."
Research
Sex Hormone Influences on Venous Thrombotic and Cardiovascular Risk Journal Link
"Thrombosis is a recognized complication of sex hormone therapy, which includes hormone replacement for deficiencies, contraceptive therapy, treatment of heavy menstrual bleeding, gender-affirming hormone therapy, suppression of ovulation, oncologic hormone therapy, and assisted reproduction. This review examines the effects of sex hormones on hemostasis and the vasculature and summarizes current evidence on thrombotic risk, including the effects of hormone formulation, thrombophilias, previous thrombosis, and common clinical factors. Practical guidance on the prevention and treatment of hormone-associated venous thromboembolism, as well as on perioperative care of patients receiving sex hormone therapy, is also provided."
🍁 "We thank Drs. Nathalie Saad and Lorraine Lau at the University of Calgary for providing content expertise in the area of transgender persons, gender-affirming hormone therapy, and hormone-replacement therapy."
Author: Leslie Skeith, M.D., M.H.P.E., and Shannon M. Bates, M.D.C.M.
Publication: N Engl J Med 2026;394:1514-1528
Date: 15 April 2026
DOI: 10.1056/NEJMra2202438
Amsterdam UMC: Transgender women do not have an increased risk of heart attack and stroke
"In transgender women, but also in women from the general population, oestradiol appears to have a protective effect on the heart and blood vessels. Martin den Heijer, professor of endocrinology at Amsterdam UMC, says: “Earlier studies suggested a higher risk of heart attack and stroke for transgender women compared to people with the same birth sex, that is, men from the general population. We did not really understand this. Now, however, we find no increased risk of heart and brain infarctions for transgender women who use oestradiol. These findings fit well with what we know about the presumed protective effects of oestradiol on the heart and blood vessels. With this research, we have solved a paradox that has occupied us for a long time.” Previous studies on cardiovascular disease in transgender people were often small-scale and limited to short periods, which could explain the earlier contradictory research results."
Transgender persons receiving gender-affirming hormone therapy: risk of acute cardiovascular events in a Dutch cohort study
📑 Direct Link 🔓 Open Access
"Despite favourable effects of oestradiol on cardiovascular risk factors, previous studies found higher risks of cardiovascular events in transgender women using gender-affirming hormone therapy. However, these studies did not adjust for socioeconomic status and lifestyle. This study investigated the association between gender-affirming hormone therapy and cardiovascular event risk in a large cohort of transgender persons compared with the general population, accounting for these factors."
Author: Lieve Mees van Zijverden, Abel Thijs, Jeske Joanna Katarina van Diemen, Chantal Maria Wiepjes, Martin den Heijer
Publication: European Heart Journal, 2025;, ehaf837
Date: 4 Nov 2025
DOI: 10.1093/eurheartj/ehaf837
Gender-affirming hormone therapy and cardiovascular health in transgender adults Journal Link
"Transgender patients also appear to be at higher risk for cardiovascular diseases compared to their cisgender peers and the impact of gender-affirming therapy on cardiovascular health is unclear. Studies on the effect of GAHT on cardiovascular outcomes are confounded by differences in GAHT regimens and methodological challenges in a diverse and historically hard-to-reach population. Current cardiovascular guidelines do not incorporate gender identity and hormone status into risk stratification and clinical decision-making. In this review, we provide an overview on the cardiometabolic impact and clinical considerations of GAHT for cardiovascular risk in transgender patients."
Author: Ong, C., Monita, M., & Liu, M.
Publication: Climacteric, 27(3), 227–235
Date: 10 Apr 2024
DOI: 10.1080/13697137.2024.2310518
Cardiovascular disease in transgender people: a systematic review and meta-analysis
📑 Direct Link 🔓 Open Access
"The use of hormone therapy might be associated with an increased risk of cardiovascular disease in transgender people, but evidence is limited. By conducting an extensive literature search, we found that both transgender women and men have an increased risk of major cardiovascular events compared with people with the same birth sex. These findings highlight the potential influence of socio-economic and lifestyle factors on cardiovascular health in this population."
Author: Lieve Mees van Zijverden, Chantal Maria Wiepjes, Jeske Joanna Katarina van Diemen, Abel Thijs, Martin den Heijer
Publication: European Journal of Endocrinology, Volume 190, Issue 2, February 2024, Pages S13–S24
Date: 01 Feb 2024
DOI: 10.1093/ejendo/lvad170
"Many early studies described a higher risk of cardiovascular morbidity and mortality in trans women, but many earlier studies utilized ethinyl estradiol which is no longer used as GAHT."
Transgender Cardiovascular Health: Practical Management for the Clinician Journal Link
"Transgender individuals represent a growing part of our population with current trends indicating that clinicians will be treating more transgender patients in both the inpatient and outpatient setting. Current cardiovascular guidelines lack recommendations for transgender care secondary to limited data in this population. As we await future guideline recommendations, we provide a comprehensive review of the literature and practical management strategies related to transgender cardiovascular health."
Author: Women and Ischemic Heart Disease (J.M. Peña and F. Lin, Section Editors)
Publication: Curr Atheroscler Rep 24, 721–730 (2022)
Date: 29 June 2022
DOI: 10.1007/s11883-022-01047-1
Prevalence and Predictors of Cardiovascular Disease and Risk Factors in Transgender Persons in the United States
📑 Direct Link
"In this contemporary cross-sectional nationally representative survey, CVD was prevalent in nearly 14% of TGD persons. Further studies examining interventions to reduce CV risk and enhance access to medical care in the TGD population are warranted."
Author: Aditi Malhotra, Smadar Kort, Tara Lauther, Noelle Mann, Hal A Skopicki, Puja B Parikh
Publication: Crit Pathw Cardiol. 2022 Mar 1;21(1):42-46.
Date: March 2022
DOI: 10.1097/HPC.0000000000000271
Discrimination, stress linked to poorer heart health in transgender, gender diverse adults
"The stress of experiencing discrimination in multiple ways, including transphobia, interpersonal discrimination, violence and public policies specifically targeting transgender and gender diverse (TGD) people, is linked to higher rates of heart disease among the TGD population, according to a new scientific statement from the American Heart Association, published today in Circulation, the Association’s flagship journal. A scientific statement is an expert analysis of current research and may inform future guidelines. The statement, Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse, examines existing research about TGD-specific cardiovascular health disparities, identifies research gaps and provides suggestions for systematically improving overall heart health and care of TGD people."
Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association
📑 Direct Link 🔓 Free Article
"This American Heart Association scientific statement reviews the existing literature on the cardiovascular health of people who are TGD. When applicable, the effects of gender-affirming hormone use on individual cardiovascular risk factors are also reviewed. Informed by a conceptual model building on minority stress theory, this statement identifies research gaps and provides suggestions for improving cardiovascular research and clinical care for people who are TGD, including the role of resilience-promoting factors. Advancing the cardiovascular health of people who are TGD requires a multifaceted approach that integrates best practices into research, health promotion, and cardiovascular care for this understudied population."
Author: American Heart Association
Publication: Circulation, Volume 144, Issue 6, 10 August 2021; Pages e136-e148
Date: 8 July 2021
DOI: 10.1161/CIR.0000000000001003
Assessment of Cardiovascular Risk in Transgender Patients Presenting for Gender-Affirming Care Journal Link
"The described transgender population had much higher rates of mental health disorders and substance use than the general population. Furthermore, there were high rates of undiagnosed and untreated comorbidities, such as hypertension and dyslipidemia, that increase risk for cardiovascular disease. Baseline risk assessment using the ASCVD (Atherosclerotic Cardiovascular Disease) and QRISK3 calculators showed higher-than-expected cardiovascular risk, particularly given the young age of our patient population."
Author: Kara J. Denby, MD, Leslie Cho, MD, Karlo Toljan, MD, Meghana Patil, MD, Cecile A. Ferrando, MD, MPH
Publication: The American Journal of Medicine, 2021; 134, 1002-1008
Date: 22 April 2021
DOI: 10.1016/j.amjmed.2021.02.031
Risk for Venous Thromboembolism in Transgender Patients Undergoing Cross-Sex Hormone Treatment: A Systematic Review Journal Link
"Feminizing and masculinizing hormone treatments are established components of management in transgender patients. Exogenous hormones have been associated with hemostatic effects, which are well-studied in cis-gender individuals on hormone replacement therapy (HRT). Unfortunately, comprehensive understanding of their effects on venous thromboembolism (VTE) risk in the transgender population is lacking." "AMAB patients on hormone therapy have higher VTE rates than AFAB patients. AMAB and AFAB patients may have similar VTE incidence to cis-female and cis-male patients on hormone replacement therapy, respectively."
Author: Vasanth S. Kotamarti, Nicolas Greige, Adee J. Heiman, Ashit Patel, Joseph A. Ricci
Publication: The Journal of Sexual Medicine, Volume 18, Issue 7, July 2021, Pages 1280–1291
Date: 14 June 2021
DOI: 10.1016/j.jsxm.2021.04.006
Does Gender-Affirming Hormonal Treatment Affect 30-Year Cardiovascular Risk in Transgender Persons? A Two-Year Prospective European Study (ENIGI) Journal Link
"In transwomen a significant decrease in triglycerides, total cholesterol and LDL-cholesterol was observed during the 2-year follow-up (P < .05), whereas unfavorable lipid changes – such as increased total cholesterol, triglycerides, and LDL cholesterol levels and decreased HDL cholesterol levels (P < .05)- occurred after the start of GAHT in transmen. These changes in risk factors led to an increase in the risk of general and hard CVD events based on lipid profile over time in transmen (P = .001 and P = .005, respectively). No significant changes in general and hard CVD risk based on lipid profile were observed in transwomen over time."
Author: Carlotta Cocchetti, Giovanni Castellini, Davide Iacuaniello, Alessia Romani, Mario Maggi, Linda Vignozzi, Thomas Schreiner, Martin den Heijer, Guy T’Sjoen, Alessandra Daphne Fisher
Publication: The Journal of Sexual Medicine, Volume 18, Issue 4, April 2021, Pages 821–829
Date: 18 March 2021
DOI: 10.1016/j.jsxm.2021.01.185
Gender-Affirming Hormone Therapy, Vascular Health and Cardiovascular Disease in Transgender Adults
📑 Direct Link 🔓 Open Access
"This review explores the available evidence on the associations between gender-affirming hormones and cardiovascular events such as coronary artery disease, stroke, hypertension, thrombosis, lipid abnormalities, and diabetes mellitus. Current research about vascular outcomes in adults receiving hormonal therapy is limited by the absence of large cohort studies, lack of appropriate control populations, and inadequate data acquisition from gender identity services. Existing epidemiological data suggest that the use of estrogens in transgender females confers an increased risk of myocardial infarction and ischemic stroke. Conversely, transgender males receiving testosterone lack any consistent or convincing evidence of increased risk of cardiovascular or cerebrovascular disease."
Author: Paul J. Connelly, E. Marie Freel, Colin Perry, John Ewan, Rhian M. Touyz, Gemma Currie, and Christian Delles
Publication: Hypertension Volume 74, Number 6
Date: 28 Oct 2019
DOI: 10.1161/HYPERTENSIONAHA.119.13080
Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population
📑 Direct Link 🔓 Free Article
"Approximately 1.4 million adults identify themselves as transgender, and the number of transgenders seeking gender-affirming hormone therapy is increasing. The transgender community has a higher rate of behavioral and cardiovascular disease risk factors compared with the cisgender population due to the increase in social stressors, health disparity, and poor socioeconomic status. The majority of studies to date have not demonstrated a higher risk of myocardial infarction in the transgender population likely due to the small sample sizes and the younger subjects of these studies."
"This study is the first investigation of a large cohort of subjects from the United States, which demonstrates an association between being transgender and the reported history of myocardial infarction. These data may help to further risk stratify these patients to reduce the rate of myocardial infarction in this population and achieve health equality."
Author: American Heart Association
Publication: Circulation: Cardiovascular Quality and Outcomes, Volume 12, Number 4
Date: 5 April 2019
DOI: 10.1161/CIRCOUTCOMES.119.005597
Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study Journal Link
"Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use." "The patterns of increases in VTE and ischemic stroke rates among transfeminine persons are not consistent with those observed in cisgender women. These results may indicate the need for long-term vigilance in identifying vascular side effects of cross-sex estrogen."
Author: Darios Getahun, MD, PhD, MPH et. al.
Publication: Annals of Internal Medicine Volume 169, Number 4
Date: 10 July 2018
DOI: 10.7326/M17-2785
Sex Steroids and Cardiovascular Outcomes in Transgender Individuals: A Systematic Review and Meta-Analysis
📑 Direct Link 🔓 Free Access
"Low-quality evidence suggests that sex steroid therapy may increase LDL-C and TG levels and decrease HDL-C level in FTM individuals, whereas oral estrogens may increase TG levels in MTF individuals. Data about important patient outcomes remain sparse."
Author: Spyridoula Maraka, Naykky Singh Ospina, Rene Rodriguez-Gutierrez, Caroline J Davidge-Pitts, Todd B Nippoldt, Larry J Prokop, M Hassan Murad
Publication: The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 11, 1 November 2017, Pages 3914–3923
Date: 13 Sept 2017
DOI: 10.1210/jc.2017-01643
Thrombotic issues in transgender medicine: A review
📑 Direct Link 🔓 Free Access
"Data on the hematologic complications of these therapies are accumulating but remain limited, and clinicians have little experience with their management. This review highlights the current interventions available in transgender medicine and related potential hematologic complications, and it suggests simple, evidence-based management going forward."
Author: Shatzel, J.J., Connelly, K.J. and DeLoughery, T.G.
Publication: Am. J. Hematol., 92: 204-208
Date: 25 Oct 2016
DOI: 10.1002/ajh.24593
Resources
The Derm Review: Transgender Skin Care: A Guide for Addressing Dermatological Issues in Trans Patients
"As the trans men and women continue to overcome more and more cultural and bias-related hurdles that directly affect quality and accessibility of healthcare, they also continue to encounter unique and, to a large extent, lesser-discussed issues that can impact health, quality of life and desired treatment outcomes; one of these issues is certain skin-care issues that emerge through hormone replacement therapy and other transitioning interventions and facilitators. Hormone therapies and gender-affirming procedures can affect the skin and change the prevalence and presentation of routine skin conditions."
Allure: How Going on Estrogen Changed My Skin
"Thinking of starting hormone replacement therapy? Here's everything you need to know about how estrogen can impact your skin, hair, and nails, courtesy of someone who's been there."
Research
Issues in transgender dermatology: A systematic review of the literature Journal Link
"Dermatologists have the ability to improve the care of transgender patients by providing specialized dermatologic care and providing safe and noninvasive treatment options for transitioning patients. Here we have reviewed the literature and highlighted opportunities to expand our knowledge of how to best care for our transgender patients."
Author: Patrick Sullivan MD, John Trinidad MD MPH, Dathan Hamann MD
Publication: Journal of the American Academy of Dermatology Volume 81, Issue 2, August 2019, Pages 438-447
Date: Aug 2019
DOI: 10.1016/j.jaad.2019.03.023
Dermatologic Conditions in Transgender Populations Journal Link
"Transgender persons face unique burdens of dermatologic conditions related to cutaneous effects of gender-affirming hormone therapy and procedures. Skin diseases in transgender patients often are underdiagnosed and underrecognized despite potential for significant impairments in quality of life and mental health from skin diseases. For transmasculine patients, common conditions include acne vulgaris and MPHL. For transfeminine patients, common conditions include hirsutism, PFB, and melasma."
Author: Howa Yeung MD, Benjamin Kahn BA, Bao Chau Ly BS, Vin Tangpricha MD, PhD
Publication: Endocrinology and Metabolism Clinics of North America Volume 48, Issue 2, June 2019, Pages 429-440
Date: June 2019
DOI: 10.1016/j.ecl.2019.01.005
A potential role for the dermatologist in the physical transformation of transgender people: A survey of attitudes and practices within the transgender community Journal Link
"By examining attitudes and practices of transgender individuals, we aimed to identify areas for which dermatologists could contribute to their physical transformation." "A total of 327 people completed the survey (63% men, 29% women, 9% other). Most transgender women indicated that their face was most imperative to have changed, whereas men noted their chest, in turn influencing procedures. Of women's facial procedures, hair removal predominated, followed by surgery then injectables, mostly performed by plastic surgeons. Hormone-induced facial effects varied, usually taking over 2 years for maximal effect. When choosing procedures, money was the major barrier and good aesthetic outcome the primary concern. Participants did not think that facial procedures necessitate the currently accepted prerequisites for chest and genital surgery."
Author: Brian A. Ginsberg MD, Marcus Calderon BS, Nicole M. Seminara MD, Doris Day MD, MA
Publication: Journal of the American Academy of Dermatology Volume 74, Issue 2, February 2016, Pages 303-308
Date: Feb 2016
DOI: 10.1016/j.jaad.2015.10.013
Resources
ARUP Consult: Monitoring of Gender-Affirming Hormone Therapy Testing Algorithm
"The typical goals of gender-affirming hormone therapy are to suppress endogenous sex steroids and maintain exogenous sex steroids within the reference interval of the affirmed gender or within a range that achieves the desired outcome. Testosterone concentrations, and in some cases estradiol concentrations, should be measured regularly during and after gender-affirming hormone therapy."
Research
Approach to prolactin monitoring and hyperprolactinaemia in transgender and gender-diverse individuals undergoing gender affirming hormone therapy
📑 Direct Link 🔓 Free Article
"Given the knowledge that estrogens can stimulate growth of lactotroph cells and case reports of prolactinoma in trans individuals treated with feminising GAHT, some guidelines recommend monitoring serum prolactin concentration. Notably, there are sex-specific serum prolactin reference ranges in the general population, with reference intervals higher in the female population. It should also be noted that the initial observations of hyperprolactinaemia and prolactinomas were in individuals prescribed estrogen formulations and cyproterone acetate doses that are no longer recommended, so the utility of routine prolactin monitoring must be weighed against potentially unnecessary investigations and associated healthcare costs. There are two unanswered questions. Firstly, should clinicians routinely monitor prolactin in trans individuals undergoing feminising GAHT? Secondly, how should clinicians approach investigation and management of trans individuals with symptomatic hyperprolactinaemia?"
Author: Nolan BJ, Accatino MI, Angus LM and Cheung AS
Publication: Front. Endocrinol. 16:1608108
Date: 26 May 2025
DOI: 10.3389/fendo.2025.1608108
Gender-affirming hormone treatment: friend or foe? Long-term follow-up of 755 transgender people Journal Link
"The aim of the study is to investigate the long-term therapeutic management of GAHT, considering hormonal targets, treatment adjustments and GAHT safety.
Methods: A retrospective, longitudinal, observational, multicentre clinical study was carried out. Transgender people, both AMAB and AFAB, were recruited from two Endocrinology Units in Italy (Turin and Modena) between 2005 and 2022. Each subject was managed with specific and personalized follow-up depending on the clinical practice of the Centre. All clinical data routinely collected were extracted, including anthropometric and biochemical parameters, lifestyle habits, GAHT regime, and cardiovascular events."
Author: Santi, D., Spaggiari, G., Marinelli, L. et al.
Publication: J Endocrinol Invest 47, 1091–1100 (2024).
Date: 24 May 2023
DOI: 10.1007/s40618-023-02220-2
Changes in laboratory results in transgender individuals on hormone therapy: a retrospective study and practical approach
📑 Direct Link 🔓 Open Access
"Interpreting laboratory results for transgender individuals who started hormone therapy requires careful consideration, specifically for analytes that have sex-specific reference intervals. In literature, conflicting data exist on the effect of hormone therapy on laboratory parameters. By studying a large cohort, we aim to define what reference category (male or female) is most appropriate to use for the transgender population over the course of gender-affirming therapy." "For transgender women, Hb and Ht levels decrease after initiation of hormone therapy. The concentration of liver enzymes ALT, AST, and ALP decreases whereas the levels of GGT do not change statistically significantly. Creatinine levels decrease whereas prolactin levels rise in transgender women during gender-affirming therapy. For transgender men, Hb and Ht values increase after starting hormone therapy. Liver enzymes and creatinine levels increase statistically significantly as well upon hormone therapy while prolactin concentrations decrease. Overall, reference intervals in transgender people after 1 year on hormone therapy resembled those of their affirmed gender."
Author: Evelien T M Boekhout-Berends, Chantal M Wiepjes, Nienke M Nota, Hans H M Schotman, Annemieke C Heijboer, Martin den Heijer
Publication: European Journal of Endocrinology, Volume 188, Issue 5, May 2023, Pages 457–466
Date: 24 May 2023
DOI: 10.1093/ejendo/lvad052
Potential immunological effects of gender-affirming hormone therapy in transgender people – an unexplored area of research
📑 Direct Link 🔓 Open Access
"There are well-described sex-based differences in how the immune system operates. In particular, cisgender (cis) females have a more easily activated immune system; associated with an increased prevalence of autoimmune diseases and adverse events following vaccinations. Conversely, cis males have a higher threshold for immune activation, and are more prone to certain infectious diseases, such as coronavirus disease (COVID-19). Oestrogen and testosterone have immune-modulatory properties, and it is likely that these contribute to the sexual dimorphism of the immune system."
Author: White AA, Lin A, Bickendorf X, et al.
Publication: Therapeutic Advances in Endocrinology and Metabolism. 2022;13
Date: 10 Dec 2022
DOI: 10.1177/20420188221139612
Longitudinal Changes in Liver Enzyme Levels Among Transgender People Receiving Gender Affirming Hormone Therapy
📑 Direct Link 🔓 Open Access
"The effect of gender affirming hormone therapy (GAHT) on clinical laboratory parameters, including levels of liver enzymes alanine aminotransferase (ALT) and aspartate transaminase (AST), is an area of uncertainty in transgender health." "TM persons may experience modest increases in ALT and AST concentrations following testosterone initiation; however, clinical significance of the observed association remains unclear and requires further investigation. By contrast, feminizing GAHT is unlikely to induce appreciable changes in liver enzyme levels."
Author: Leila Hashemi, Qi Zhang, Darios Getahun, Guneet K. Jasuja, Courtney McCracken, Joseph Pisegna, Douglas Roblin, Michael J. Silverberg, Vin Tangpricha, Suma Vupputuri, Michael Goodman
Publication: The Journal of Sexual Medicine, Volume 18, Issue 9, September 2021, Pages 1662–1675
Date: 5 Aug 2021
DOI: 10.1016/j.jsxm.2021.06.011
Which reference range should we use for transgender and gender diverse patients?
📑 Direct Link 🔓 Open Access
"The sex/gender item may leave transgender patients wondering whether to select their affirmed gender or the one corresponding to legal documents. What if somebody is nonbinary? Will the selection determine whether the provided services (eg, Papanicolaou test, prostate-specific antigen test) will be covered or denied by somebody’s health insurance?"
Author: Michael S. Irwig
Publication: The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 3, March 2021, Pages e1479–e1480
Date: 18 Sep 2020
DOI: 10.1210/clinem/dgaa671
Approach to Interpreting Common Laboratory Pathology Tests in Transgender Individuals
📑 Direct Link 🔓 Open Access
"As the number of transgender (trans) people (including those who are binary and/or nonbinary identified) seeking gender-affirming hormone therapy rises, endocrinologists are increasingly asked to assist with interpretation of laboratory tests. Many common laboratory tests such as hemoglobin, iron studies, cardiac troponin, and creatinine are affected by sex steroids or body size. We seek to provide a summary of the impact of feminizing and masculinizing hormone therapy on common laboratory tests and an approach to interpretation."
Author: Ada S Cheung, Hui Yin Lim, Teddy Cook, Sav Zwickl, Ariel Ginger, Cherie Chiang, Jeffrey D Zajac
Publication: The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 3, March 2021, Pages 893–901
Date: Aug 2020
DOI: 10.1210/clinem/dgaa546
Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline
📑 Direct Link 🔓 Free Article
"Objective: To update the “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline,” published by the Endocrine Society in 2009."
Author: Wylie C Hembree, Peggy T Cohen-Kettenis, Louis Gooren, Sabine E Hannema, Walter J Meyer, M Hassan Murad, Stephen M Rosenthal, Joshua D Safer, Vin Tangpricha, Guy G T’Sjoen
Publication: The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 11, 1 November 2017
Date: 13 Sep 2017
DOI: 10.1210/jc.2017-01658
Serum prolactin levels in transgender persons before and during cross-sex hormonal treatment
📑 Direct Link 🔓 Free Article
"In MtF’s an increase in mean serum prolactin levels was seen whereby those levels exceeded mean serum prolactin levels of biological women. In FtMs a decrease in mean serum prolactin levels was seen whereby those levels did not reach the values of biological men. In both groups the biggest change was observed during the first 3 months of treatment."
Mount Sinai Transgender Headache Medicine Program
"Transgender and gender-diverse people can experience various types of headaches throughout their lifetime. The most common type of headache that may bring a patient to see a specialist is migraine. Migraine is often a lifelong problem, but the frequency and severity of episodes may fluctuate over time. Migraine can be debilitating and cause symptoms of light and sound sensitivity, dizziness, nausea, or vomiting, and can last for hours or days. Everyone experiences migraines differently, so treatment plans are made to suit each person’s medical needs. The Transgender Headache Medicine Program can help to support you and uses various treatments to help reduce the frequency and severity of attacks while you are receiving gender-affirming hormone therapy (GAHT) or undergoing gender-affirming surgical interventions."
Shedding Light on Headache Disorders in Transgender and Gender-Diverse Adults and Youth
"Some cases have been reported of transgender women on estrogen who develop cerebral venous sinus thrombosis. This is one diagnosis a physician does not want to miss when evaluating a patient on estrogen with new-onset headache, especially if it’s persistent and associated with vision changes, nausea and vomiting, or other red flags. Transgender women on estrogen may also have a higher rate of benign masses such as meningiomas and prolactinomas, which may present with headache."
"There are a handful of case reports of transgender individuals on gonadotropin-releasing hormone (GnRH) agonists and transgender men on testosterone who developed idiopathic intracranial hypertension (IIH). While IIH is not thought of intuitively as a “secondary headache,” case reports suggest IIH develops as a result of hormones or GnRH agonism, leading to the assumption that testosterone or androgen excess may affect cerebrospinal fluid production."
The American Migraine Foundation Migraine in Transgender People
"“Hormones can affect migraine in cisgender women based on some of the studies on postmenopausal women who are on hormone replacement therapy or studies that look into people who have been on oral contraceptive pills,” says Dr. Pace. “However, we don’t have a lot of data on transgender individuals who are going through hormone therapy, but based on data in cisgender populations, we think that estrogen may play a role in the development of aura.”
"There is not a lot of research about the impact of transition surgeries on migraine frequency. But we can get insights from research on similar procedures. Research in cisgender patients who have hysterectomies and oophorectomies, removal of the uterus and ovaries, have both shown an increase in the frequency of migraine attacks immediately after surgeries. “If an individual’s estrogen levels are high and then they quickly drop because the ovaries are removed, that drop in hormones can lead to more attacks,” says Dr. Pace."
Your Questions on Migraine in Transgender People Answered
"Any change of hormones, either an increase or decrease, could potentially affect migraine, says Dr. Pace. There hasn’t been enough research to say for certain that testosterone is a trigger of migraine in an individual. But some patients on testosterone may experience fewer attacks. Changes in testosterone levels may affect how frequently migraine attacks occur."
"While there is no specific data about stroke risk in transgender people, data on women whose gender identify matches their biological sex show aura can be worsened by estrogen, and women with aura are at a slightly higher risk of stroke compared to the general population."
Webinar Recap: Migraine in the LGBTQ+ Community
"In February 2023, the American Migraine Foundation hosted a webinar discussion exploring how migraine impacts the LGBTQ+ community and what people can do to help break down these barriers to care."
"Why are migraine rates higher among the LGBTQ+ community? More research is needed, but one prominent theory points the finger at higher levels of stress, a known migraine trigger. The additional stigma and discrimination faced by many LGBTQ+ individuals—both in accessing medical care and in other situations—can contribute to higher levels of stress. Another theory adds that lack of social safety for stigmatized individuals is what leads to worse health outcomes. Even when faced with discrimination, having social safety can buffer against the effects of minoritized stress. Panelist Joseph Coe recently discussed this topic with researcher Nicole Rosendale, MD, Assistant Clinical Professor at the University of California, San Francisco. Dr. Rosendale works on the PRIDE Study, the first large-scale, long-term study of LGBTQ+ individuals in the United States. “[The study] found that social stresses and discrimination affect migraine severity and disability in the LGBTQ+ community,” says Coe. “As a gay person, I was not surprised by that, but it was very validating to hear.”"
American Headache Society Migraine in Transgender Patients
"A recent study out of the Netherlands found that, in the male-to-female transgender population, about 26% of patients that transitioned actually adopted migraine characteristics, which is about the same as the general population. That is the most complete data set that we have. We do know that hormones play a role in headache, but we’re still trying to figure exactly what role they play. Interestingly, patients who are taking hormone therapy are often suppressing some hormones, and they’re keeping more consistent levels, rather than having peaks and valleys. Again, there’s a lack of data to tell us exactly what’s going on in these patients. It is interesting—maybe with male-to-female transition, with the use of estrogen—that they approach migraine frequency that mimics the general population." "There are some medications that we might want to avoid in certain folks’ transitions, such as beta blockers, since they interfere with some of the hormones. But aside from that, I don’t think that there are too many preventative medications that would directly interfere with that hormone therapy."
Research
Headache in individuals undergoing hormone therapy for gender transition: A cross-sectional, observational study
📑 Direct Link 🔓 Open Access
"Many transgender people receive hormone therapy as part of their gender-affirming care, but little is known about how these treatments affect headache. In this study, we surveyed 160 transgender and nonbinary individuals in Argentina to explore whether hormone therapy influences the frequency or severity of headache; we found that people using estrogen were more likely to report new or worsening headache, whereas those using testosterone often experienced less frequent or less intense headache. These findings suggest that hormone therapy may influence headache patterns and underscore the need for personalized headache care in transgender health."
Author: Zavala LJ, Gil Ramirez A, Vetvik KG, Jensen RH, Hougaard A.
Publication: Headache. 2026;66:725-732.
Date: 16 Oct 2025
DOI: 10.1111/head.15076
Headache in transgender men using gender-affirming hormone therapy: A case–control study Journal Link
"This study aimed to compare the frequency, characteristics, and impact of primary headaches in transgender men (TM), cisgender men (CM), and cisgender women (CW)."
Problems in management of medication overuse headache in transgender and gender non-conforming populations
📑 Direct Link 🔓 Open Access
"Since gender-affirming sex hormone therapy influences migraine progression, transgender and gender non-conforming (trans*) patients on hormone therapy have a higher risk for worsening migraine symptoms. However, trans* patients are less likely to have access to appropriate pain management techniques, thus preventing positive health outcomes for this vulnerable population."
Author: Martinez CI, Liktor-Busa E and Largent-Milnes TM
Publication: Front. Neurol. 15:1320791.
Date: 29 Jan 2024
DOI: 10.3389/fneur.2024.1320791
Headache prevalence in transgender and gender diverse youth: A single-center case–control study Journal Link
"Transgender and gender-diverse youth are an understudied group in whom we can study the effects of sex steroids on adolescents’ development of headache. We hypothesized that transfeminine adolescents treated with estrogen would have higher odds of headache than those not treated, and that transmasculine adolescents treated with testosterone would have lower odds of headache than those not treated."
Author: Hranilovich JA, Millington K.
Publication: Headache. 2023;63:517-522.
Date: 29 March 2023
DOI: 10.1111/head.14493
Primary headaches among gender dysphoric female-to-male individuals: A cross-sectional survey on gender transition experience Journal Link
"Objective: To investigate the frequency, attack characteristics, and treatment experiences of migraine and tension-type headache (TTH) among gender dysphoric female-to-male (FtM) participants as well as in relation to psychiatric comorbidities and real-life experience that relates to being transgender in Turkey."
Author: Yalinay Dikmen P, Ertas M, Kosak S, et al.
Publication: Headache. 2021;61:1194–1206.
Date: 31 Aug 2021
DOI: 10.1111/head.14203
American Migraine Foundation: Improving Migraine Care for Transgender and Gender-Diverse Patients
"Transgender and gender-diverse patients often don’t get the migraine care they need, mainly due to a lack of knowledge in healthcare. A study looks at the unmet needs of this underserved population. An article in Headache recently shed light on the issues of transgender people who experience migraine."
Headache in transgender and gender-diverse patients: A narrative review Journal Link
"The manuscript is a narrative review of current best practices in treating transgender patients, including the use of appropriate terminology and ways to create a supportive environment. It also contains current guidelines on GAHT and reviews drug–drug interactions and secondary headache related to hormone therapy. We also review transgender headache research and related research on hormonal effects on headache in cisgender individuals."
Author: Hranilovich JA, Kaiser EA, Pace A, Barber M, Ziplow J.
Publication: Headache. 2021;61:1040–1050.
Date: 7 Aug 2021
DOI: 10.1111/head.14171
Updates on management of headache in women and transgender women Journal Link
"Recent studies highlight differences in how migraine and cluster headache present in women and men. Updates to the ongoing debate of how to manage the use of hormones in women with migraine, especially with aura, have been well reviewed in the last 18 months. A new meta-analysis evaluates gender differences in response to triptans."
Author: Jessica Ailani
Publication: Current Opinion in Neurology 34(3):p 339-343, June 2021.
Date: June 2021
DOI: 10.1097/WCO.0000000000000926
Resources
AIDSVu: National Transgender HIV Testing Day Toolkit 2026
"There has historically been a lack of comprehensive data on transgender people living with HIV, which continues to limit targeted public health planning, resource allocation, and effective programming for this community. Recent limitations in the availability and completeness of federally reported transgender health data further compound these challenges, meaning some data may be less current or comprehensive than in previous years. AIDSVu uses data-driven public health insights to highlight these gaps and incorporates the most recent available local and peer-reviewed data to inform understanding of HIV impacts, barriers to care, and opportunities for intervention among transgender individuals."
Gender Affirming Care at UC San Francisco Transgender health and HIV
"HIV and its treatment are not contraindications to hormone therapy. In fact, providing hormone therapy in the context of HIV care may improve engagement and retention in care as well as adherence and viral load. The World Health Organization as well as the U.S. Department of Health and Human Services recommend antiretroviral therapy for everyone living with HIV, regardless of HIV viral load or CD4 count."
📑 UC San Francisco: Trans HIV Testing Toolkit
"As part of the NTHTD initiative, the Center of Excellence for Transgender Health (CoE) developed a Transgender HIV testing toolkit that reflects the most current HIV prevention research, and best practices for serving trans and gender non-binary people. Guidelines to increase access and trans cultural competence among HIV testing programs and services are included. With this toolkit, the CoE encourages CBOs and prevention programs to host trans HIV testing community events, develop trans HIV testing visibility campaigns, provide HIV testing services, and/or engage trans community members in promoting status awareness among all trans people."
The United Nations Development Programme: TRANSIT
📑 Direct Link
"This tool contains practical advice on implementing HIV and sexually transmitted infection (STI) programmes with transgender people. It is based on recommendations in the Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, published in 2014 by the World Health Organization."
"The tool is designed for use by public-health officials, managers of HIV and STI programmes, NGOs – including community and civil-society organizations – and health workers. It may also be of interest to international funding agencies, health policy-makers and advocates. This transgender implementation tool is known informally as the TRANSIT and is the third in a series of tools on implementing HIV and STI programmes with key populations."
Research
HIV seropositivity and viral non-suppression in transgender, non-binary, and gender-diverse people in primary care receiving gender-affirming hormone therapy in the USA between 2013 and 2019 (LEGACY): an observational, longitudinal, cohort study
📑 Science Direct Link
"Gender-affirming hormone therapy is medically necessary for many transgender, non-binary, and gender-diverse (trans) individuals and might improve HIV clinical outcomes for trans people. This study evaluated gender-affirming hormone therapy delivered in primary care as an intervention to improve HIV outcomes for trans adults in the USA."
Author: Reisner S, Pletta D, Mayer K et al.
Publication: The Lancet HIV, 2025; 12, e283-e292
Date: March 27 2025
DOI: 10.1016/S2352-3018(25)00004-9
Effects of Gender-Affirming Hormone Therapy on Progression Along the HIV Care Continuum in Transgender Women
📑 Direct Link 🔓 Open Access
"Patients were on average 35 years old and Black (86%), with a median CD4 count of 464 cells/µL. There were 13 patients on GAHT at study entry and 31 receiving GAHT at any point during the study period. Fifty-five percent were virally suppressed at study entry and 86% at GAHT initiation. The proportion of TGWWH who were consistently virally suppressed over time was greater among those receiving GAHT compared with those who were not (P = .04)." "Rates of viral suppression were significantly greater among TGWWH receiving GAHT when compared with those who were not. More research to evaluate the reasons behind this effect is needed."
Author: Nathan A Summers, Trang T Huynh, Ruth C Dunn, Sara L Cross, Christian J Fuchs
Publication: Open Forum Infectious Diseases, Volume 8, Issue 9, September 2021
Date: 30 July 2021
DOI: 10.1093/ofid/ofab404
HIV Infection, Risk, Prevention, and Testing Behaviors Among Transgender Women—National HIV Behavioral Surveillance, 7 U.S. Cities, 2019–2020.
📑 Direct Link 🔓 Free Access
"This report summarizes findings from the first NHBS-Trans data collection cycle, which was con- ducted in 2019–2020. Transgender women, especially transgender women of color, are disproportionately affected by HIV [8]. This report provides descriptive, unweighted data that can be used to describe HIV infection among transgender women and the percentages of transgender women reporting specific behaviors, HIV testing, access to care, participation in prevention programs, gender-affirming medical treatment, experiences of abuse and harassment, and suicidality. Collecting these data is useful for assessing risk, access to care and treatment, the use of prevention efforts, and other social structural factors affecting HIV prevention opportunities for this population."
Author: Centers for Disease Control and Prevention
Publication: HIV Surveillance Special Report 27
Date: April 2021
The Effect of Efavirenz on Estradiol Metabolism in Transgender Women
📑 Direct Link 🔓 Free Article
"Although efavirenz is no longer a first-line therapy in HIV care in the Western world, it is still used frequently elsewhere due to cost and other considerations. Hence, drug–drug interactions with efavirenz can be clinically important. We discuss here three transgender HIV-positive women on estradiol therapy and how the serum 17-β estradiol levels were affected by concomitant use of efavirenz."
Author: Leinung MC, Miller CH, Tehrani B, Joseph J.
Publication: Transgender Health. 2019;4(1):197-199
Date: 4 Sep 2019
DOI: 10.1089/trgh.2019.0018
Characterizing the Human Immunodeficiency Virus Care Continuum Among Transgender Women and Cisgender Women and Men in Clinical Care: A Retrospective Time-series Analysis
🍁📑 Direct Link 🔓 Open Access
"Prior studies suggest that transgender women (TW) with human immunodeficiency virus (HIV) are less likely to be virally suppressed than cisgender women (CW) and cisgender men (CM). However, prior data are limited by small sample sizes and cross-sectional designs. We sought to characterize the HIV care continuum comparing TW to CW and CM in the United States and Canada."
Author: Tonia Poteat, David B Hanna, Peter F Rebeiro, Marina Klein, Michael J Silverberg, Joseph J Eron, Michael A Horberg, Mari M Kitahata, W C Mathews, Kristin Mattocks, Angel Mayor, Ashleigh J Rich, Sari Reisner, Jennifer Thorne, Richard D Moore, Yuezhou Jing, Keri N Althoff
Publication: Clinical Infectious Diseases, Volume 70, Issue 6, 15 March 2020, Pages 1131–1138
Date: 23 April 2019
DOI: 10.1093/cid/ciz322
(Dis)integrated Care: Barriers to Health Care Utilization for Trans Women Living With HIV
🍁 Journal Link
"Transgender (trans) women have been particularly impacted by HIV. To seek insights into the dynamics of health service utilization, interviews were conducted with trans women living with HIV (n = 14) as part of the Trans PULSE community-based research project in Ontario, Canada. Service providers (n = 10) were also interviewed to provide additional details about communication between trans women, social service providers, and clinicians. Results highlight how both problematic interactions with individuals and health systems navigation challenges affect access to services and impede the development of trans-specific HIV supports. Participants described discrimination, identified strategies for navigating a dysfunctional system, and outlined specific ways in which health and social services may be failing trans women living with HIV. Findings support the importance of coordinating HIV services and transition-related care, and providing training for service providers."
Author: Lauren Munro BA (Hons), Zack Marshall MSW, RSW, Greta Bauer PhD, MPH, Rebecca Hammond BA (Hons), MSc, BScN, RN, Caleb Nault BA (Hons), Robb Travers PhD
Publication: Journal of the Association of Nurses in AIDS Care Volume 28, Issue 5, September–October 2017, Pages 708-722
Date: 25 Aug 2017
DOI: 10.1016/j.jana.2017.06.001
Retention in Care and Health Outcomes of Transgender Persons Living With HIV
📑 Journal Link
"Little is known about the health outcomes of transgender persons living with human immunodeficiency virus (HIV), or PLWH [1]. Discrimination and social isolation may decrease engagement in care, while concerns about adverse interactions between antiretroviral therapy (ART) and hormone therapy may reduce ART receipt and medication adherence in this population [2–4]. We examined whether retention in care, use of ART, and HIV suppression differed between transgender and nontransgender PLWH."
Author: Baligh R. Yehia, John A. Fleishman, Richard D. Moore, Kelly A. Gebo
Publication: Clinical Infectious Diseases, Volume 57, Issue 5, 1 September 2013, Pages 774–776
Date: 1 Sept 2013
DOI: 10.1093/cid/cit363
VODA.co: The Trans+ Wellbeing Library
"The world’s largest free mental health resource created by and for the trans+ community."
"The library contains 52 self-care and wellbeing programmes that address the most pressing issues for the trans+ community. Whether you're managing the emotional toll of waiting for gender-affirming care, or building resilience against transphobia, there is something designed to help you."
FORGE Questions to ask at a first therapy visit
"Many therapists offer free phone interviews. This is a great opportunity to learn about their approach and determine if they can meet your needs. Here are some questions you may want to ask a potential new therapist."
Therapist First Impressions Checklist
"When you have your first session with a new mental health care provider, it can be helpful to evaluate your feelings and determine your next steps. This checklist offers some suggestions for reflecting on a first visit with a therapist and deciding whether or not you’d like to come back for another visit."
Research
Mental Health Care for People Who Identify as Two Spirit, Lesbian, Gay, Bisexual, Transgender, and (or) Queer (2SLGBTQ+)
🍁📑 Direct Link 🔓 Open Access
"This position paper addresses the need for psychiatrists to increase their understanding of the mental health needs of people who identify themselves as two spirit, lesbian, gay, bisexual, transgender, queer and other minority sexual orientations and gender identities (2SLGBTQ+) with a particular focus on the need for a more comprehensive approach to care for transgender and gender diverse individuals. While the Canadian Psychiatric Association (CPA) has taken a strong position in advocating for decreasing stigma and discrimination, the focus of antistigma advocacy has centred most significantly on people with mental illness. While doing so, however, the CPA has recognized the ongoing stigma and discrimination in society based on several factors, including sex, gender, race, sexual orientation and religion. Psychiatry has a history of conflating 2SLGBTQ+ identities with mental illness and has, therefore, historically contributed to the stigma and discrimination faced by people who identify as 2SLGBTQ+, affecting not only their mental health but also their access to appropriate mental health care."
Author: Veltman A, Rose TL, Chaimowitz G.
Publication: 🍁The Canadian Journal of Psychiatry. 2024;69(2):140-155
Date: 14 Jan 2025
DOI: 10.1177/07067437231195727
In spite of the system: A qualitatively-driven mixed methods analysis of the mental health services experiences of LGBTQ people living in poverty in Ontario, Canada
🍁📑 Direct Link 🔓 Open Access
"Indeed, for our participants who had been affected by poverty and violence throughout their lives, the mental health system had never met their needs, and at times had operated (often in concert with other state systems, such as child welfare) as a source of violence and oppression. As a result, participants in this study described working in resourceful and creative ways to take care of themselves and others in their communities, largely identifying and establishing resources outside of the formal mental health system. The hard work our participants described doing to accomplish taking care of themselves and their communities stands in stark contrast to dominant social narratives about people living in poverty as ‘lazy’, ‘socially disordered’ (i.e., deviant), or ‘cheating the system’. Our finding that low income LGBTQ people work to create resources and supportive spaces to meet not only their own, but also their peers’ unmet needs similarly stands in contrast to individualist narratives of poor people as undeserving of assistance due to moral or other personal failings."
Author: Ross LE, Gibson MF, Daley A, Steele LS, Williams CC
Publication: 🍁PLOS ONE 13(8): e0201437
Date: 15 Aug 2018
DOI: 10.1371/journal.pone.0201437
ADHD
ADDitude ADHD and Transgender Health Care: Guidance for Clinicians
"The periodic adjustment of gender-affirming hormone therapy and its impact on ADHD medication efficacy must be tracked carefully; otherwise, a previously therapeutic ADHD treatment regimen may become frustratingly ineffective. In my clinical practice, providing adaptive ADHD care – adjusting ADHD medications to account for changes in hormone therapy and connecting transgender patients to non-pharmacological resources such as therapy or support groups – has resulted in improved emotional regulation, decreased anxiety, and less symptom variability. Some of these individuals have been able to decrease their reliance on other medications, such as antidepressants or mood stabilizers."
When Children with ADHD Explore Gender Identity: A Guide for Parents
"There is nothing short of a cultural revolution taking place as today’s youth challenge long-held notions of gender and work to express their authentic selves. Simply put, the discussion around gender identity is no longer a taboo topic – and thank goodness. Simultaneously, many adult caregivers are left scratching their heads and playing catch-up, wondering how to understand and address the changing gender landscape to best support their children, teens, and young adults. For children with ADHD, gender identity exploration is undoubtedly a process impacted by the unique facets of their neurodiverse brains. To fully support these children in a safe and appropriate way, parents, educators, and professionals must understand the intersection of neurodiversity and gender diversity. Doing so can help protect them from negative mental health consequences and strengthen family bonds when they are needed most."
ADHD Aha! Episode 50
"Max Siegel (he/they) was diagnosed with ADHD as an adult. Throughout that process, Max encountered some of the same fears and myths around ADHD as he does around transness: “You just want an excuse.” “You just want to be lazy.” Max, an LGBTQ+ transgender and neurodiversity inclusion speaker and consultant, found that coming out gave him resilience. And that same resilience helped him cope with his ADHD diagnosis. Max and host Laura Key also talk about ADHD symptoms and gender identity. Max, who was assigned female at birth, was socialized as a woman until his 20s. He talks about anxiety, rejection sensitivity, and other ADHD-related challenges he’s faced — and how ADHD can get missed because of a person’s gender."
ADHD Research
Transgender Identity and Attention Deficit Hyperactivity Disorder Symptoms: Findings From the Adolescent Brain Cognitive Development Study
📑 Direct Link 🔓 Open Access
"Self-reported transgender status (B = 3.41; 95% confidence interval = 0.79−6.04; p = .011) and gender-questioning status (B = 2.72; 95% confidence interval = 0.79−4.65; p = .006) were both associated with higher ADHD symptom scores when compared to cisgender peers after adjusting for sociodemographic variables. In models adjusting for stress problems and depression as well as sociodemographic variables, the associations between transgender and gender-questioning status and ADHD symptoms were attenuated and no longer statistically significant.
Discussion: Our results indicate that gender minority status may be linked to higher ADHD symptom scores, potentially due to higher minority stress."
Author: Elizaveta Ignatova M.D., Priyadharshini Balasubramanian M.P.H., Julia H. Raney M.D., Kyle T. Ganson Ph.D., M.S.W., Alexander Testa Ph.D., M.P.P., Jinbo He Ph.D., Fiona C. Baker Ph.D., Jason M. Nagata M.D., M.Sc.
Publication: Journal of Adolescent Health Volume 76, Issue 3, March 2025, Pages 396-400
Date: 13 Feb 2025
DOI: 10.1016/j.jadohealth.2024.10.015
The Transgender and Gender Diverse and Attention Deficit Hyperactivity Disorder Nexus: A systematic review
📑 Direct Link
"Prior work suggests an increased prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among transgender and/or gender diverse (TGD) individuals. This systematic review summarizes primary literature on TGD/ADHD experience."
Author: Teddy G. Goetz & 🍁Noah Adams
Publication: Journal of Gay & Lesbian Mental Health
Date: 15 Aug 2022
DOI: 10.1080/19359705.2022.2109119
Gender dysphoria and attention problems: possible clue for biological underpinnings
📑 Direct Link
"Ninety per cent of the cases with gender dysphoria had at least one psychiatric diagnosis. Attention-deficit/hyperactivity disorder (ADHD) (75%) was the leading comorbidity, followed by major depressive disorder (25%). Gender dysphoria group had significantly higher scores in communication, roles, affective involvement, and general family functioning subscales of FAD and in all Child Behavior Checklist subscales."
Author: Yildirim, B., Perdahli Fis, N., Yazkan Akgul, G., & Ayaz, A. B.
Publication: Psychiatry and Clinical Psychopharmacology, 27(3), 283–290.
Date: 27 Jul 2017
DOI: 10.1080/24750573.2017.1354417
Autism
TransLash Guide for Trans People on the Spectrum
"In honor of World Autism Awareness Day, team TransLash made a list of resources to support TGNC folks on the spectrum. Team TransLash celebrates that being neurodivergence is something we can be proud about. For many within our community, the journey of understanding gender identity happens alongside the journey of understanding neurodivergence. Research and lived experiences consistently show a significant overlap between being transgender or non-binary and being on the autism spectrum."
"Whether you are seeking an affirming therapist, a support group that understands your sensory needs, or simply a community that validates your entire self without asking you to mask, you are not alone. In this TransLash guide, we have compiled a comprehensive list of resources, organizations, and media dedicated to the intersection of being trans and on the spectrum."
Autism Research
Transgender and gender diverse autistic adults’ experiences of (un)belonging
📑 Direct Link 🔓 Open Access
"Participants discussed their experiences of (un)belonging across three levels: macro, encompassing work and volunteering; meso, including education, gender identity healthcare, and neurodivergent groups and spaces; and micro, including relationships and creating chosen families. Participants faced workplace exclusion and healthcare gatekeeping, often turning to self-employment or community spaces for inclusion. Some found belonging in autistic or queer communities, while others struggled with accessibility and sensory barriers."
Author: Katie Munday, Steven K. Kapp, Charlotte Morris
Publication: PLOS ONE 20(12): e0338569
Date: 18 Dec 2025
DOI: 10.1371/journal.pone.0338569
Health and Health Care Access of Autistic Transgender and Nonbinary People in Canada: A Cross-Sectional Study
🍁📑 Direct Link 🔓 Open Access
"We report on a subanalysis of the 2019 Trans PULSE Canada survey on the health and well-being of 2873 TNB people in Canada. Our study explored the health and health care experiences of the 406 participants who indicated that they were diagnosed with autism or self-identified as autistic when asked. We conducted statistical analyses to compare the responses of autistic TNB individuals with allistic participants in the wider Trans PULSE Canada study."
Author: Adams N, Jacobsen K, Li L, et al.
Publication: Autism in Adulthood. 2025;7(1):66-80.
Date: 5 Feb 2025
DOI: 10.1089/aut.2023.0024
Co-occurring Autism Spectrum Disorder and Gender Dysphoria in Adolescents
📑 Direct Link 🔓 Free Article
"Among 919,898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72–3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth."
Author: Nicole F. Kahn, Gina M. Sequeira, Michelle M. Garrison, Felice Orlich, Dimitri A. Christakis, Tandy Aye, Lee Ann E. Conard, Nadia Dowshen, Anne E. Kazak, Leena Nahata, Natalie J. Nokoff, Raina V. Voss, Laura P. Richardson
Publication: Pediatrics August 2023; 152 (2): e2023061363
Date: 3 July 2023
DOI: 10.1542/peds.2023-061363
Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis
📑 Direct Link 🔓 Open Access
"To our knowledge, this is the most up-to-date systematic review of the literature pertaining the overlap between ASD and GD/GI, and it is also the first meta-analysis of the prevalence of ASD diagnoses and ASD traits in GD/GI people. The findings of the current literature review and meta-analyses suggest that there is (a) a positive relationship between ASD traits and GD/GI feelings among people from the general population, (b) an increased prevalence of GD/GI in the autistic population, and (c) an increased prevalence of ASD diagnoses and ASD traits in the GD/GI population. Overall, these findings suggest the existence of a link between ASD and GD/GI that warrants the investigation of mechanisms that could explain that link and the intensification of clinical attention to autistic GD/GI individuals."
Author: Kallitsounaki, A., Williams, D.M.
Publication: J Autism Dev Disord 53, 3103–3117 (2023)
Date: 20 May 2022
DOI: 10.1007/s10803-022-05517-y
Largest study to date confirms overlap between autism and gender diversity
"People who do not identify with the sex they were assigned at birth are three to six times as likely to be autistic as cisgender people are, according to the largest study yet to examine the connection. Gender-diverse people are also more likely to report autism traits and to suspect they have undiagnosed autism."
Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals
📑 Direct Link 🔓 Open Access
"In this study, we investigated three primary questions, and an additional exploratory question using five different, large-scale datasets. First, across all five datasets, transgender and gender-diverse individuals were 3.03 to 6.36 times as likely to be autistic than were cisgender individuals, after controlling for age and educational attainment. Second, transgender and gender-diverse individuals scored significantly higher on self-report measures of autistic traits, systemizing and sensory sensitivity and scored significantly lower on empathy traits compared to cisgender individuals. Third, in two datasets with available data, transgender and gender-diverse individuals had elevated rates of multiple other neurodevelopmental and psychiatric conditions. Finally, exploratory analysis identified that transgender and gender-diverse individuals were more likely to report that they suspected they had undiagnosed autism."
Author: Warrier, V., Greenberg, D.M., Weir, E. et al.
Publication: Nat Commun 11, 3959 (2020)
Date: 7 Aug 2020
DOI: 10.1038/s41467-020-17794-1
Autism + ADHD Research
Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review Direct Link
"To ensure neurodevelopmental conditions are adequately considered in gender health services, we aimed to systematically review the literature examining the prevalence of ASD and ADHD amongst individuals with GD. In this systematic review based on the PRISMA guidelines. MEDLINE and PsycINFO databases were searched for studies examining the prevalence of ASD and/or ADHD in individuals with GD or investigated the rate of GD in cohorts with ASD or ADHD."
Author: Thrower, E., Bretherton, I., Pang, K.C. et al.
Publication: J Autism Dev Disord 50, 695–706 (2020).
Date: 15 Nov 2019
DOI: 10.1007/s10803-019-04298-1
Increased Gender Variance in Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder
📑 Research Gate Link
"In the first study to compare the occurrence of wishing to be the other gender (gender variance) among children and adolescents with different neurodevelopmental disorders relative to non-referred control groups, we found participants with ASD to have significantly elevated rates of gender variance. Gender variance was 7.59 times more common in participants with ASD than in a large non-referred comparison group." "This is the first report of an overlap between ADHD diagnosis and comorbid gender variance, though previous studies have shown increased levels of behavioral problems and/or disruptive disorders among young people with gender variance."
Author: Strang, J.F., Kenworthy, L., Dominska, A. et al.
Publication: Arch Sex Behav 43, 1525–1533 (2014).
Date: 12 March 2014 DOI: 10.1007/s10508-014-0285-3
Resources
🍁 Ontario Osteoperosis Strategy Providing Care for Transgender Patients, presented by Dr. Tehmina Ahmad MD, FRCPC
"This presentation will focus on bone health in transgender individuals. Participants will learn about the effects of hormones on bone mass accrual during cis- and trans- puberty and factors impacting lower bone mass in transgirls. The presentation will also review the relevant guideline recommendations and new literature for bone health in transgender adults."
📑 Presentation Slides
Gender Affirming Care at UC San Francisco Bone Health and Osteoporosis
"There is insufficient evidence to guide recommendations for bone density testing in transgender women or men. Transgender people (regardless of birth-assigned sex) should begin bone density screening at age 65. Screening between ages 50 and 64 should be considered for those with established risk factors for osteoporosis. Transgender people (regardless of birth assigned sex) who have undergone gonadectomy and have a history of at least 5 years without hormone replacement should also be considered for bone density testing, regardless of age." "Weak evidence suggests that agonadal states contribute to an increased risk of osteoporosis, however long term studies are lacking. Transgender people without gonads, and who are not using hormone replacement, should follow screening and prevention guidelines for agonadal or postmenopausal women, regardless of birth-assigned sex or gender identity."
The Mayo Clinic Managing skeletal issues in transgender and gender-nonconforming individuals
"Although bone mineral density (BMD) is generally preserved in both transgender women and transgender men, there are sparse data on fracture risk. In the largest fracture study to date, which included 2,023 transgender women and 1,036 transgender men, fracture risk was not increased in transgender men when compared with either reference cisgender men or cisgender women, but it tended to be increased in transgender women younger than 50 years when compared with age-matched reference cisgender women but not when compared with age-matched reference cisgender men. In transgender women older than 50 years, fracture risk was similar to that of age-matched reference cisgender women, but was increased almost twofold compared with that of age-matched reference cisgender men. "Whether this risk differential is related to the underlying skeletal deficits in transgender women even prior to starting hormone treatment noted earlier remains to be determined," says Dr. Khosla."
Research
Impact of 1 year of gender-affirming hormone therapy on bone mineral density in adults with gender incongruence: a cross-sectional study Journal Link
"While testosterone and estrogen are known determinants of bone health, the effects of GAHT on BMD in transgender individuals, particularly those who have attained peak bone mass, remain incompletely understood. From a previous study, for 80% power, the sample size was calculated to be 29 individuals in both groups. This study presents a cross-sectional evaluation of 60 transgender adults (31 transgender women and 29 transgender men) with data collected over a period of 6 months with subjects aged 18 to 40 years, all having undergone GAHT for at least one year after peak bone mass attainment."
Author: J M Sanjana, MD, Vanitha Gowda M N, MD, Pramila Kalra, DM
Publication: The Journal of Sexual Medicine, Volume 23, Issue 1, January 2026
Date: 27 Dec 2025
DOI: 10.1093/jsxmed/qdaf357
Bone health in transgender assigned female at birth people: effects of gender-affirming hormone therapy and gonadectomy
📑 Direct Link 🔓 Open Access
"This was a single-center, longitudinal study with retrospectively collected data. TGD AFAB GAHT-naïve individuals were enrolled and underwent dual-energy X-ray absorptiometry scans and laboratory tests (hormonal and bone metabolism parameters) at baseline and after 5 and 10 years of GAHT." "The strength of this study is that it is one of the few studies with a long-term follow-up of up to 10 years, combining densitometric data with hormonal data and parameters of bone metabolism. It also provides implications in the context of surgical options that can be offered to transgender AFAB individuals, allowing for adequate counseling and tailored choice based on people’s needs."
Author: Sanna E, Lami A, Giacomelli G, Alvisi S, Paccapelo A, Seracchioli R and Meriggiola MC
Publication: Front. Endocrinol. 15:1416121
Date: 25 Sept 2024
DOI: 10.3389/fendo.2024.1416121
"Trans women with low estradiol (<182 pmol/l) have significant reductions in areal BMD over time and increased bone remodeling markers. In trans men who started GAHT aged <50 years, bone remodeling markers increased, but in those aged >50 years (presumed postmenopausal) bone remodeling markers decreased over the first 12 months of testosterone therapy."
"Concerns regarding compromised bone microstructure and fracture risk appear to be relevant for trans women only and lifestyle factors may reduce attainment of peak bone mass. In young trans people, the role of routine measurement of BMD is not clear. However, all trans women should be encouraged to optimize their bone health through engaging in regular weight-bearing exercise, smoking cessation, optimization of vitamin D levels and ensuring adequate dosing of GAHT to achieve estradiol concentrations >182 pmol/l."
Bone health in transgender people: a narrative review
📑 Direct Link 🔓 Open Access
"Prior to gender-affirming hormone treatment (GAHT), transwomen have lower bone mineral density (BMD) and a higher prevalence of osteopenia than cismen probably related to external factors, such as hypovitaminosis D and less physical activities. Gonadotropin-releasing hormone (GnRH) analogues in transgender youth may cause bone loss; however, the addition of GAHT restores or at least improves BMD in both transboys and transgirls. The maintenance or increase in BMD shown in short-term longitudinal studies emphasizes that GAHT does not have a negative effect on BMD in adult transwomen and transmen. Gonadectomy is not a risk factor if GAHT is taken correctly."
Author: Giacomelli G, Meriggiola MC.
Publication: Therapeutic Advances in Endocrinology and Metabolism. 2022;13
Date: 27 May 2022
DOI: 10.1177/20420188221099346
Bone Densitometry in Transgender and Gender Non-Conforming (TGNC) Individuals: 2019 ISCD Official Position Journal Link
"The indications for initial and follow-up bone mineral density (BMD) in transgender and gender nonconforming (TGNC) individuals are poorly defined, and the choice of which gender database to use to calculate Z-scores is unclear. Herein, the findings of the Task Force are presented after a detailed review of the literature. As long as a TGNC individual is on standard gender-affirming hormone treatment, BMD should remain stable to increasing, so there is no indication to monitor for bone loss or osteoporosis strictly on the basis of TGNC status."
Author: Harold N. Rosen, Ole-Petter R. Hamnvik, Unnop Jaisamrarn, Alan O. Malabanan, Joshua D. Safer, Vin Tangpricha, Lalita Wattanachanya, Swan S. Yeap
Publication: Journal of Clinical Densitometry Volume 22, Issue 4, October–December 2019, Pages 544-553
Date: 2019
DOI: 10.1016/j.jocd.2019.07.004
Effect of Sex Steroids on the Bone Health of Transgender Individuals: A Systematic Review and Meta-Analysis
📑 Direct Link 🔓 Free Access
"In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain."
Author: Naykky Singh-Ospina, Spyridoula Maraka, Rene Rodriguez-Gutierrez, Caroline Davidge-Pitts, Todd B Nippoldt, Larry J Prokop, Mohammad Hassan Murad
Publication: The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 11, 1 November 2017, Pages 3904–3913
Date: 13 Sept 2017
DOI: 10.1210/jc.2017-01642
General Resources
Pelvic Floor Therapy for Gender Affirming Care
"There is a lack of awareness and education surrounding pelvic health and the anatomy of our bodies and a misconception regarding who has a pelvic floor. Transgender individuals are not an exception to pelvic floor dysfunction and for some, gender affirming modalities and surgeries are an essential step in the transition process and/or the journey to gender euphoria. The purpose of this article is to educate folks about how pelvic floor therapy can improve outcomes of gender-affirming care."
🍁 CanSAGE: Pelvic Pain Management Videos & Resources
"Our pain management video library helps you understand pelvic pain, what therapies are available, and how to use tools like breathing, stretching, and mindfulness to improve quality of life. These videos and resources are recommended by Canadian doctors and international pain specialists."
General Research
Pelvic floor and sexual dysfunctions after genital gender-affirming surgery: a systematic review and meta-analysis Journal Link
"Pelvic floor dysfunctions following genital gender-affirming surgery are an emerging issue. Adequate information for each surgical procedure, explicit postoperative instructions, continuity of care, communication with healthcare providers, and recommendation for tailored perioperative pelvic floor physiotherapy are necessary for a better surgical result."
Author: Mattia Dominoni, Annachiara Licia Scatigno, Marianna Francesca Pasquali, Carola Bergante, Fulvio Gariboldi, Barbara Gardella
Publication: The Journal of Sexual Medicine, Volume 22, Issue 1, January 2025, Pages 184–195
Date: 14 Nov 2024
DOI: 10.1093/jsxmed/qdae146
Transfeminine Resources
Pelvic Obstetric and Gynaecological Physiotherapy (POGP UK) Pelvic floor muscle exercises and advice - A guide for trans women, trans feminine and non-binary people (who were assigned male at birth)
"The booklet is for trans/non-binary people who were assigned male at birth, who either are yet to undergo or do not desire gender affirming genital surgery or are awaiting gender affirming/lower/genital surgery. It will explore aspects of pelvic health, with reference to sex and genitals. Throughout the booklet we refer to the penis as the ‘erectile tissue’ and utilise as little gendered language as possible, whilst maintaining clarity about which parts of the body are being discussed." "Undergoing gender affirming surgeries such as vaginoplasty or orchidectomy can have a big impact on pelvic health and the pelvic floor plays a significant role in someone’s recovery from any of those procedures. However, certain exercises in this booklet may not be recommended for those who are recovering from surgery."
📑 Direct Link
Transfeminine Research
Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty Journal Link
"We conducted a retrospective, single-institution study on vaginoplasty patients between May 1, 2016, and February 28, 2018; all were referred for pelvic floor PT. We reviewed medical records for baseline demographics, medical comorbidities, prior surgeries, insurance data, attendance at pelvic floor PT, and dilation success at 3 and 12 months."
Author: Jiang, Da David MD; Gallagher, Sandra PT; Burchill, Laura PT; Berli, Jens MD; Dugi, Daniel III MD, FACS
Publication: Obstetrics & Gynecology 133(5):p 1003-1011, May 2019
Date: May 2019
DOI: 10.1097/AOG.0000000000003236
Transmasculine Resources
Pelvic Obstetric and Gynaecological Physiotherapy (POGP UK) Pelvic floor muscle exercises and advice - A guide for trans men, trans masculine and non-binary people (who were assigned female at birth)
"The booklet is for trans/non-binary people who were assigned female at birth, who either are yet to undergo or do not desire gender affirming genital surgery or are awaiting gender affirming/lower/genital surgery. It will explore aspects of pelvic health, with reference to sex, body parts and pregnancy. Throughout the booklet we refer to the vagina as the ‘front-hole’ and utilise as little gendered language as possible, whilst maintaining clarity about which parts of the body are being discussed." "Undergoing gender affirming surgeries such as hysterectomy, phalloplasty or metoidioplasty can have a big impact on pelvic health and the pelvic floor plays a significant role in someone’s recovery from any of those procedures. However, certain exercises in this booklet may not be recommended for those who are recovering from surgery. "To ensure our resources are as safe and as easy to follow as possible, we have produced a separate resource specifically for those who are preparing for or recovering from gender affirming lower surgeries."
📑 Direct Link
Fit following surgery - advice for trans men, trans masculine and non-binary people following hysterectomy.
"The booklet is for trans/non-binary people who were assigned female at birth, This booklet is a general guide for people following the removal of the uterus (hysterectomy) and/or the fallopian tubes and ovaries (salpingo-oophorectomy). Throughout the booklet we refer to the vagina as the ‘front-hole’ and utilise as little gendered language as possible, whilst maintaining clarity about which parts of the body are being discussed."
📑 Direct Link
Gender Affirming Care at UC San Francisco Pelvic pain and persistent menses in transgender men
"The general approach to the workup of pelvic pain in transgender men is similar to that for non-transgender women. An anatomic approach to history gathering that considers urological, gynecologic, gastrointestinal, musculoskeletal, and psychological components is critical. Specific etiologies may be multifactorial, such as post-surgical adhesions with or without gastrointestinal symptoms, or endometriosis and/or pelvic floor muscle dysfunction. It is also critical to assess quality of life impact and determine what the patient would consider a favorable outcome. Most evaluation and treatment guidelines stress that chronic pelvic pain can be a diagnostic and therapeutic challenge, and success will depend on comprehensive and customized evaluation and multidisciplinary care."
Transmasculine Research
Pelvic Floor Dysfunction in the Transgender Patient: A Scoping Review
📑 Journal Link
"There is a high prevalence of pelvic floor dysfunction among the transgender population. Future cohort studies with better defined instruments and standardized pelvic examinations are recommended."
Author: Hatanaka, L.M.d.S.S., Pereira, G.M.V., Lara, L.A.d.S. et al.
Publication: Int Urogynecol J 36, 2145–2167 (2025)
Date: 13 October 2025
DOI: 10.1007/s00192-025-06294-9
Pelvic Floor Dysfunction in Transgender Men on Gender-affirming Hormone Therapy: A Descriptive Cross-sectional Study
📑 Journal Link
"The objective of this research is to explore the effects of hormone therapy using testosterone on pelvic floor dysfunction (PFD) in transgender men. We hypothesize that PFD might be prevalent among transgender men undergoing hormone therapy. Therefore, this study was aimed at verifying the frequency of these dysfunctions."
Author: da Silva, L.M.B., Freire, S.N.D., Moretti, E. et al.
Publication: Int Urogynecol J 35, 1077–1084 (2024)
Date: 25 April 2024
DOI: 10.1007/s00192-024-05779-3
Prevalence of pelvic pain in transgender individuals on testosterone
📑 Journal Link
"Of 280 individuals who had been on testosterone for at least 1 year, 100 (36%) experienced pelvic pain while on testosterone. Of those patients, 71% (n = 71) had not experienced pelvic pain prior to starting testosterone. There were 42 patients (15%) who had pelvic pain prior to starting testosterone, 13 (31%) of whom no longer experienced pain once starting testosterone. The median (IQR) age at initiation of testosterone was 22 (19-41) years and duration of testosterone treatment was 48 (27-251) months."
Author: Frances W Grimstad, Elizabeth R Boskey, Rachael S Clark, Cecile A Ferrando
Publication: The Journal of Sexual Medicine, Volume 20, Issue 12, December 2023, Pages 1459–1465
Date: 13 Oct 2023
DOI: 10.1093/jsxmed/qdad135
Pelvic Pain in Transgender People Using Testosterone Therapy
📑 Direct Link 🔓 Open Access
"Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted." "As clinicians (gynecologists, endocrinologists, and physiotherapists), we have seen increasing numbers of trans individuals on testosterone seeking assistance to relieve symptoms of pelvic pain. However, there is a paucity of data regarding pelvic pain in trans individuals using testosterone GAHT. Given that estradiol deficiency may lead to atrophic vaginitis, we hypothesized that pelvic pain in trans people using testosterone would be predominantly lower abdominal and would worsen with symptoms of genital dryness or penetrative sexual activities. Furthermore, we hypothesized that pre-existing endometriosis, vulvodynia, or vaginismus would be risk factors. Given the limited research on the prevalence and/or the characteristics of pelvic pain experienced by individuals using testosterone GAHT, this was an exploratory study aiming to identify the characteristics of pelvic pain in trans people using testosterone GAHT and to explore potential factors associated with experiencing pelvic pain after commencing testosterone GAHT."
Author: Sav Zwickl, PhD, Laura Burchill, Alex Fang Qi Wong, MD, Shalem Y. Leemaqz, PhD, Teddy Cook, Lachlan M. Angus, Kalen Eshin, MSocWk, Charlotte V. Elder, Sonia R. Grover, MD, Jeffrey D. Zajac, PhD, Ada S. Cheung, PhD
Publication: LGBT Health Volume 10, Issue 3, 1 April 2023, Pages 179-190
Date: 3 April 2023
DOI: 10.1089/lgbt.2022.0187
"Trans people using testosterone also frequently report pelvic pain, which is most often described as cramping in nature, and occurring in the suprapubic region or less occasionally the right and left iliac regions. The cause of this pelvic pain is poorly understood."
"The pelvic floor muscles are enriched with androgen receptors and exquisitely androgen-sensitive, with androgens causing anabolic effects on pelvic floor muscles. It is therefore plausible that masculinizing hormones may affect the pelvic floor and perineal muscles, and it is hypothesized that pelvic floor muscle dysfunction may contribute to pelvic pain. Many trans people seek hysterectomy and/or oophorectomy but effects on pelvic pain are inconsistent, with some small studies reporting improvements and little to no change in pelvic pain. Without a clear understanding of the causes of pelvic pain in people using masculinizing hormones, a multidisciplinary biopsychosocial approach is required. This may include simple analgesia with paracetamol and non-steroidal anti-inflammatory drugs and pelvic floor physical therapy with release of myofascial trigger points which has been used in cisgender individuals."
🍁 CanSAGE Foundation
"The CanSAGE Foundation was conceived in 2023 with a clear purpose: to improve gynecologic care for all individuals who need it, including cisgender, transgender, and non-binary people. Over the past three years, we’ve carefully planned our strategy, engaged with experts, and laid the groundwork to make a meaningful difference in Canada."
🍁💬 La Fondation CanSAGE
💬"La Fondation CanSAGE a été créée en 2023 avec un objectif clair : améliorer les soins gynécologiques pour toutes les personnes qui en ont besoin, y compris les personnes cisgenres, transgenres et non binaires. Au cours des trois dernières années, nous avons soigneusement élaboré notre stratégie, consulté des experts et jeté les bases pour avoir un impact concret au Canada."
The American College of Obstetricians and Gynecologists: Gender Affirming Care
"This curriculum has been created to address both creation of an inclusive environment and providing medical care for gender diverse individuals. The curriculum includes a slide set and simulation addressing creation of an inclusive environment, as well as two slide sets focused on care of transmasculine and transfeminine individuals, respectively. These resources were developed by Tess Chase, MD, Callie King, PhD, Amanda Ryan, MD and Lydia Fein, MD in conjunction with CREOG education committee members, Heisy Asusta, MD, Heather Campbell, MD and Amy Stagg, MD. In addition, video lectures that were a part of the first version of the CREOG Transgender Care Curriculum are found below. These video lectures have not been updated from the originals created in 2018; however, they may still serve as valuable resources presenting the information in an audio-visual format."
Research
Gynecologic function and dysfunction in transmasculine and gender-diverse individuals using testosterone therapy: a systematic review
📑 Direct Link 🔓 Open Access
"This systematic review provides a comprehensive and up-to-date synthesis of the current literature, integrating findings across domains of gynecologic function and dysfunction. It highlights both commonly expected physiological effects and more complex, understudied responses to testosterone, emphasizing the need for nuanced, evidence-based, and affirming care for transmasculine and gender-diverse individuals, and identifying key priorities for future research and clinical practice."
Author: Wouter L.J. van Vugt MD, Emmy van den Boogaard MD, PhD, Karin van der Tuuk MD, PhD, Laura Spinnewijn MD, PhD, Baudewijntje P.C. Kreukels PhD, Stephanie Both PhD, Judith A.F. Huirne MD, PhD, Norah M. van Mello MD, PhD
Publication: American Journal of Obstetrics and Gynecology, In Press
Date: 5 Feb 2026
DOI: 10.1016/j.ajog.2026.01.036
Gynecologic Care of Transgender and Gender-Diverse People
📑 Direct Link 🔓 Free Article
"The visibility and care of transgender and gender-diverse (TGD) people is an important component of gynecology. Transmasculine individuals require routine gynecologic and preventative care. Guidelines can be extrapolated from the cisgender female population, and using affirming language, acknowledging the challenges patients face with pelvic examination, and discussing individual gynecologic needs are important components of care. Transmasculine patients may seek hysterectomy for gender affirmation from gynecologists. Unique nuances exist in the considerations needed when preparing for hysterectomy, and patients should be thoroughly counseled with regard to concurrent vaginectomy or oophorectomy or both. Transfeminine patients often seek gynecologic care after gender-affirming surgery, and, unlike transmasculine patients, the gynecology visit is often very affirming and welcomed by patients. Becoming familiar with the perioperative and delayed postoperative care needs of transfeminine patients undergoing vaginoplasty can help improve the care provided by gynecologists."
Author: Ferrando, Cecile A. MD, MPH
Publication: Obstetrics & Gynecology 143(2):p 243-255, February 2024.
Date: Feb 2024
DOI: 10.1097/AOG.0000000000005440
LGBTQI content on obstetrics and gynecology residency websites
📑 Direct Link 🔓 Open Access
"In this review of LGBTQI content on US OB-GYN residency program websites, we found that less than a fifth of OB-GYN residency websites had any content related to the health of LGBTQI communities. In order to understand how these findings may relate to education opportunities, we also looked at the mention of LGBQI specific rotations and didactics, which were even more rare. Although residency program websites do not necessarily reflect all training opportunities, they are important for applicants who are deciding where to train, as has been demonstrated in other specialties. Our findings are at odds with the fact that most OB-GYN residents surveyed in the past have expressed interest in learning how to care for the LGBTQI population."
Author: Soltani, A., Baban, S., French, K. et al.
Publication: BMC Med Educ 23, 854 (2023)
Date: 12 Nov 2023
DOI: 10.1186/s12909-023-04624-3
Transgender men's preferences when choosing obstetricians and gynecologists
📑 Direct Link 🔓 Open Access
"Previous studies have demonstrated that transgender people’s visit to an obstetrician/gynecologist is associated with anxiety resulting from factors other than feeling during invasive procedures. In a survey of transgender men, 92% reported anxiety regarding receiving gynecological care due to the following reasons: encountering gendered forms (50%), sitting in a waiting room with cisgender women (54%), being misgendered (59%), having to educate the provider about transgender issues (70%) and undergoing the gynecologic exam itself (86%). Dutton et al. found that all of their transgender men study participants did not like receiving gynecological care not only because of the exposure of personal body part, but also because the visit itself was accompanied by an extreme emotional conflict between self-perceptions and physical anatomy."
Author: Lifshitz, D., Yaish, I., Wagner-Kolasko, G. et al.
Publication: Isr J Health Policy Res 11, 12 (2022)
Date: 11 Feb 2022
DOI: 10.1186/s13584-022-00522-z
Modalités du suivi gynécologique chez les patients transgenres — Revue de littérature
💬 Journal Link
💬 "Il n’y a à ce jour pas de recommandations claires concernant le suivi gynécologique des patients transgenres. Nous nous sommes appuyés sur les recommandations de la W-PATH (World Professional Association of Transgender Health) et sur les Guideline de l’Endocrine Society et avons réalisé une revue de littérature. Nous avons effectué plusieurs recherches via pubmed afin d’explorer un par un les différents aspects du suivi gynécologique notamment des hommes transgenres non hystérectomisés et des femmes transgenres avec une vaginoplastie. Il en ressort un manque de suivi des personnes transgenres, avec une réticence à consulter un gynécologue, associée au manque de connaissances et d’expérience des professionnels de santé."
Auteur: M. Briet, J. Barkatz, S. Frontczak, R. Ramanah, N. Chabbert Buffet, S. Cristofari
Publication: Gynécologie Obstétrique Fertilité & Sénologie Volume 50, Issue 12, pg 788-796 December 2022
Date: 23 Nov 2022
DOI: 10.1016/j.gofs.2022.09.003
Place de la préservation de la fertilité dans le parcours de transition des femmes transgenres
💬 Journal Link
💬 "L’évolution de l’accompagnement médical des personnes transgenres permet actuellement de proposer la mise en place de stratégies de préservation de la fertilité, idéalement avant l’instauration des traitements hormonaux et/ou actes chirurgicaux. La dimension « reproductive » et le désir de parentalité chez les personnes transgenres ont longtemps été ignorés. Ces aspects sont pourtant importants à considérer et des mesures de préservation de la fertilité doivent donc être discutées avant le démarrage du parcours médical de transition physique. Cette revue a pour objectif de réaliser un état des lieux de la littérature concernant la préservation de la fertilité des femmes transgenres (« male to female »)."
Auteur: E. Benaloun, N. Sermondade, E. Moreau, N. Chabbert-Buffet, S. Cristofari, N. Johnson, R. Lévy, C. Dupont
Publication: Gynécologie Obstétrique Fertilité & Sénologie Volume 49, Issue 6, pg 547-552 June 2021
Date: 22 Mai 2021
DOI: 10.1016/j.gofs.2021.01.007
Health Care for Transgender and Gender Diverse Individuals: ACOG Committee Opinion, Number 823
📑 Direct Link 🔓 Open Access
"This Committee Opinion offers guidance on providing inclusive and affirming care as well as clinical information on hormone therapy and preventive care; it also cites existing resources for those seeking information on the care of transgender adolescents. The social and economic marginalization of transgender individuals is widespread, which leads to health care inequities and poorer health outcomes for this population. To reduce the inequities experienced by the transgender community, the provision of inclusive health care is essential. Obstetrician–gynecologists should strive to make their offices open to and inclusive for all individuals and should seek out education to address health care disparities, both in their individual practices and in the larger health care system."
Author: The American College of Obstetricians and Gynecologists
Publication: Obstetrics & Gynecology 137(3):p e75-e88, March 2021
Date: March 2021
DOI: 10.1097/AOG.0000000000004294
‘None of my providers have the slightest clue what to do with me’: Transmasculine individuals’ experiences with gynecological healthcare providers Journal Link
"The aim of the present study was to explore the lived experiences of transmasculine individuals in order to understand what they feel their medical providers need to know about their experiences seeking gynecological care." "Results revealed four information-salient themes, including: 1) Patient comfort levels; 2) Language; 3) Provider assumptions; and 4) Provider knowledge."
Author: Pulice-Farrow, L., Gonzalez, K. A., & Lindley, L.
Publication: International Journal of Transgender Health, 22(4), 381–393
Date: 21 Dec 2020
DOI: 10.1080/26895269.2020.1861574
The gynecologic examination of the transfeminine person after penile inversion vaginoplasty Journal Link
"This clinical opinion aims to address that knowledge gap by describing the gynecologic examination in the transfeminine person who has undergone a penile inversion vaginoplasty. We review the anatomic changes with surgery and the neovagina’s physiology. We describe the examination of the vulva, vagina, and urethra and discuss special considerations for performing pelvic examinations on patients with a penile inversion vaginoplasty neovagina. We will also address common pathologic findings and their initial management. This clinical opinion originates from the expertise of gynecologists who have cared for high volumes of transfeminine patients who have undergone penile inversion vaginoplasties at tertiary care centers performing gender-affirming genital surgery, along with existing research on postpenile inversion vaginoplasty outcomes. Gynecologists should be familiar with the anatomic changes that occur with penile inversion vaginoplasty gender-affirming surgery and how those changes affect care. Providing transgender patients with comprehensive care including this sensitive examination can and should be part of the gynecologist’s scope of practice."
Author: Grimstad F, McLaren H, Gray M
Publication: American Journal of Obstetrics & Gynecology, 2020; 224, 266-273
Date: 7 Oct 2020
DOI: 10.1016/j.ajog.2020.10.002
The effect of testosterone on ovulatory function in transmasculine individuals Journal Link
"This study suggests that testosterone rapidly induces hypothalamic−pituitary−gonadal suppression, resulting in anovulation in a proportion of new users. Importantly, these data also suggest that some long-term testosterone users break through the hormonal suppression and experience an ovulatory event, thereby raising concerns pertaining to the need for contraception in transmasculine individuals engaged in sexual intercourse with sperm-producing partners. Given the small number of overall participants, this work is hypothesis generating. Larger studies are needed to confirm and to clarify these findings."
Author: Taub RL, Ellis SA, Neal-Perry G, et al.
Publication: American Journal of Obstetrics & Gynecology, Volume 223, Issue 2p229.e1-229.e8 August 2020
Date: 7 Feb 2020
DOI: 10.1016/j.ajog.2020.01.059
Fertility preservation options for transgender individuals
📑 Direct Link 🔓 Open Access
"In most areas of clinical medicine where treatments can impact a patient’s future fertility options fertility preservation (FP) is routinely discussed. This otherwise standard practice, however, is lacking in the care of transgender people."
"The aim of this review is to analyze the growing body of literature regarding FP in transgender patients. We discuss both current and future options allowing trans people to have their own biologic offspring, highlight the barriers limiting access to this basic right, and examine current practice patterns of physicians and health care providers specializing in transgender health."
Author: Joshua Sterling, Maurice M. Garcia
Publication: Transl Androl Urol 2020;9(Suppl 2):S215-S
Date: 19 Sep 2019
DOI: 10.21037/tau.2019.09.28
Transgender Men’s Experiences With and Perceptions of Gynecologic Care [10D] Journal Link
"Transgender men who have female reproductive organs and genitalia are in particular need of gynecologic care. OB-GYNs report a lack of training and knowledge in transgender health. In a national survey, only 29% were comfortable caring for transgender men. Additionally, transgender men report barriers to health care including negative interactions with physicians. This study was undertaken to assess transgender men’s experiences with, ability to access, and understanding of gynecologic care."
Author: Fein, Lydia A. MD, MPH; Wong, Adriana; Honorio, David; Salgado, Christopher J. MD; Medina, Carlos A. MD.
Publication: Obstetrics & Gynecology 129(5):p 44S, May 2017.
Date: 6 May 2017
DOI: 10.1097/01.AOG.0000514388.72920.d7
General Resources
Human Rights Campaign: Safer Sex for Trans Bodies
📑 Direct Link
"The HRC Foundation, in partnership with Whitman-Walker Health, released Safer Sex for Trans Bodies, a comprehensive sexual health guide for transgender and gender expansive people and their partners. The guide is written by and for members of the transgender community and offers them a long-overdue resource on potentially life-saving and affirming practices, from respectful terminology and definitions to helpful practices for sexual health following transition-related care."
Reproductive Health Access Project Contraceptive Counseling For Transgender and Gender Diverse People
"Creating a supportive, safe, and welcoming clinic environment can help reduce the barriers transgender and gender diverse individuals face when accessing reproductive health care. It is vital to understand the contraceptive needs, fertility, and reproductive goals of each individual when providing contraceptive counseling. Gender-affirming testosterone therapy alone does not prevent pregnancy."
Birth Control Across the Gender Spectrum
"When providing contraceptive counseling to LGBTQ+ patients, clinicians must take care to establish rapport and use patients’ self-identified name and gender pronouns. Clinicians should ask transgender or gender non-conforming patients what they call their body parts and employ that same language. Reproductive health care should focus on behavior rather than identity. Specific sexual behaviors may result in unplanned pregnancy, with no regard for categories/groups. For example, patients taking gender-affirming hormones such as testosterone may still be able to conceive. Patients with a penis and testes who are taking estrogen can get someone pregnant. Estrogen interacts with testosterone, but progestins do not. Progestin-only methods and non-hormonal methods are great contraceptive options for patients who take testosterone and do not wish to become pregnant. Estrogen has no interactions with contraceptives, so patients taking estrogen (and their partners) can use any indicated method."
Birth Control Across the Gender Spectrum: Fact Sheet
"This resource explains different birth control methods for people across the gender spectrum, with a focus on the effects of different forms of birth control on those taking gender-affirming hormones such as testosterone."
📑 Direct Link
FOLX HRT & Birth Control: Giving Every Body the Control They Want
"First thing’s first: hormone replacement therapy (HRT) is not a substitute for birth control. Not testosterone, not estrogen, nada. If having the type of sex in which sperm could enter the uterus of a person with ovaries who is ovulating, then pregnancy is still a real possibility. And second: there are uses for certain birth control other than pregnancy prevention! So here are a few things to consider if combining HRT and birth control."
HRT & PrEP: Ensuring Safe Sex in a Body You Can Call Home
"PrEP is a medication used to prevent or stop HIV from taking hold and spreading throughout the body. In this article, we're providing transgender health information for those on hormone replacement therapy and PrEP. Daily PrEP (such as Truvada or tenofovir) is 99% effective at preventing HIV infection through anal or vaginal sexual activity and at least 74% effective when exposed to HIV through injection drug use."
"Fortunately, PrEP doesn't decrease the effectiveness of HRT. You can continue taking PrEP without it interfering with your transition or affecting your overall quality of life."
General Research
🍁 Sexually transmitted and blood-borne infections in transgender and non-binary people in Canada: A scoping review
📑 Direct Link 🔓 Open Access
"In the 2021 census, 100,815 people in Canada aged 15 and older identified as transgender or non-binary. Globally, transgender people are disproportionately burdened by several Sexually Transmitted and Blood-Borne Infections (STBBIs) but limited data are available in Canada. Transgender and non-binary people are recognised as key populations in the STBBI Action Plan 2024–2030. We conducted a scoping review of the evidence relating to STBBI prevalence; risk exposures; and use of STBBI testing, treatment and prevention services among transgender and non-binary people in Canada."
Author: Bigio J, Butler M, Sood S, Cox J, Jackson B, et al.
Publication: PLOS ONE 20(5): e0322521
Date: 18 Dec 2025
DOI: 10.1371/journal.pone.0322521
Transfeminine
FOLX Estrogen HRT and Sexual Function
"Sexual pleasure looks different for everyone. For transgender women, trans femmes, non-binary and intersex people exploring or taking estrogen gender-affirming hormone therapy (GAHT), there are important things to know about how estrogen HRT can affect sexual health."
Transfeminine Research
Sexuality and erectile function in transgender women prior to gender-affirming surgery: a descriptive study Journal Link
"Despite the notable increase in gender transition pathways and gender-affirming surgeries over the past decades, the sexuality of transgender women remains insufficiently explored. Current evidence in transgender women’s sexual health relies largely on a small number of studies focusing primarily on postoperative functional outcomes following vaginoplasty. In contrast, data describing sexuality prior to gender-affirming genital surgery remain scarce."
Author: Benoît Mesnard, MD, PhD, Paul Neuville, MD, PhD, Lucas Freton, MD, Ismael Chelghaf, MD, Nicolas Couteau, MD, Nicolas Morel Journel, MD, François-Xavier Madec, MD
Publication: The Journal of Sexual Medicine, Volume 23, Issue 5, May 2026
Date: 6 May 2026
DOI: 10.1093/jsxmed/qdag125
Transmasculine
FOLX Five Ways Your Sex Life Can Change After Testosterone HRT
"Ever wondered how or if your sex life might change after starting testosterone hormone replacement therapy? Here are five ways that your sex life can change on T for transgender and nonbinary people."
STI Guide for People on Testosterone HRT/GAHT
"If materials about STIs do happen to include transgender people, transgender women are usually centered in these discussions. The point is, there aren't a ton of resources out there on the sexual behaviors and experiences of transgender men, transmasculine people, and other non-binary or genderfluid folks. That’s why we’ve set out to create an STI guide for folks on gender-affirming testosterone GAHT/HRT."
🍁💬 RÉZO Santé Le Guide HoT
💬 "Ton soutien nous permet de maintenir et enrichir nos programmes de prévention du VIH, des ITSS, ainsi que nos services de promotion de la santé sexuelle, mentale et sociale. Des enjeux essentiels pour les communautés GBTQ+."
"Le projet de création de ce guide est né de la volonté de documenter les réalités vécues et de proposer une ressource fiable pour démystifier les enjeux vécus par les hommes trans et les personnes transmasculines. Il se veut un outil d’éducation et de sensibilisation, lisible d’un côté pour les hommes trans et les personnes transmasculines et de l’autre côté pour les personnes cisgenres désireuses d’en apprendre davantage sur les réalités trans. Il est notamment question de santé sexuelle et des moyens de prévention adaptés. Enfin, il permet de sensibiliser les hommes cisgenres qui aiment les hommes aux réalités des personnes trans afin de favoriser leur inclusion dans le milieu gai."
📑 Primed²: A Sex Guide for Trans Men into Men (Updated Edition)
"This sex guide is written for trans men who are into men. It contains important information about staying sexually, mentally and emotionally safe and healthy. Primed was originally published in 2007 and updated in 2015. It was written by the Gay, Bi, Queer Trans Men’s Working Group; a group of trans and non-trans community members and service providers across Ontario that address sexual health issues. Topics covered include finding sex, having safer sex, and how to prevent HIV and other sexually transmitted infections. This is the updated edition of Primed."
Transmasculine Research
Testosterone use and sexual function among transgender men and gender diverse people assigned female at birth Journal Link
"Testosterone use among transgender men and gender diverse people was associated with an increased interest in sexual activity and the ability to orgasm, as well as with vaginal pain or discomfort during sexual activity. Notably, the available evidence demonstrates that >60% of transgender men experience vulvovaginal pain during sexual activity. The causes of pelvic and vulvovaginal pain are poorly understood but are likely multifactorial and include physiological (eg, testosterone-associated vaginal atrophy) and psychological factors (eg, gender affirmation). Given this high burden, there is an urgent need to identify effective and acceptable interventions for this population."
Author: Tordoff DM, Lunn MR, Chen B, et al.
Publication: American Journal of Obstetrics & Gynecology, 2023; 229, 669.e1-669.e17
Date: 4 Sep 2023
DOI: 10.1016/j.ajog.2023.08.035
Contraception across the transmasculine spectrum Journal Link
"The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered."
Author: Chance Krempasky, FNP-BC, WHNP-BC, Miles Harris, FNP-BC, Lauren Abern, MD, Frances Grimstad, MD, MS
Publication: American Journal of Obstetrics and Gynecology, Volume 222, Issue 2 p134-143 February 2020
Date: 5 Aug 2019
DOI: 10.1016/j.ajog.2026.01.036
They/Them/Their
