Pros and Cons of Hormone Therapy for Older Transsexuals

An estimated 71% of transsexuals use or intend to use gender-affirming hormone therapy (GAHT). Although the sample sizes are comparatively small, there are studies that demonstrate the psychological benefits of GAHT, while others suggest additional health risks. A presentation at the North American Menopause Society (NAMS) annual meeting in Atlanta, Oct. 12-15, will address the various pros and cons of hormones for transgender people.

Understanding the risks and benefits of GAHT for middle-aged and older women is important because it is estimated that nearly one quarter (23%) of transsexuals women start hormone therapy after age 40, with 12% starting GAHT after age 50. Specific areas of focus include mental, cardiovascular and breast health.

Numerous studies have documented improvements in the mental health and overall well-being of transgender women who use GAHT. Data collected as part of the National Transgender Discrimination Study examined the quality of life outcomes of transgender people over the age of 60 and found that those who had recently started GAHT reported statistically higher quality of life than their age-matched peers who had not started GAHT .

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

A multivariate analysis demonstrates how transgender women feel myocardial infarction approximately twice as high as in cisgender women, and similar trends were observed in ischemic stroke. Studies evaluating the risk of breast cancer in transgender women using GAHT have produced mixed results, mainly due to limited sample size.

Dr. Sarah Pickle of the University of Cincinnati College of Medicine will present this information at the NAMS Annual Meeting and discuss the current GAHT guidelines and additional considerations for the management of transgender patients.

“For the majority transgender women and transfeminine people, the well-documented benefits of gender-affirming hormone therapy far outweigh the potential risks. This is important for medical workers to understand how to counsel patients and reduce potential risks of hormone therapy, recognizing that transgender patients are more likely to have adverse health outcomes due to discrimination, marginalization, and lack of access to care than side effects hormone therapy,” says Dr. Pickle.

“This study is extremely valuable to healthcare professionals seeking guidance on how to best care for their transgender patients. Among other things, it confirms that more research is needed in transgender populations so that health professionals can make treatment recommendations with greater confidence,” says Dr. Faubion, NAMS Medical Director.