Drug Therapy for Gender Transitions and Health Screenings in Transgender Older Adults

Abstract

Transgender medicine is a relatively new field in health care, with only a small amount of evidence-based literature available for reference. This is especially true for the older adult population, for whom most information must be extrapolated from younger adults. Be it a newly transitioned older adult or a transgendered individual who has been undergoing hormonal therapy for many years, it is important that healthcare professionals be aware of the significant effects that transgender pharmacotherapy can have on older adults. Healthcare providers must also recommend appropriate preventative screenings to transgendered persons.

A narrative review of literature on the use of health and social care by older trans adults: what can United Kingdom services learn?

“…Long-term treatment with hormones may result in physical health problems, e.g. trans women who have cardiovascular risk factors and who start on oestrogen therapy have a higher risk of cardiovascular problems and may need careful monitoring (Mahan et al, 2016;Gooren and T'Sjoen, 2018), and Mahan et al (2016) note that testosterone can increase the risk of destabilising some psychiatric conditions, e.g. bipolar and schizoaffective disorders.…”

“…bipolar and schizoaffective disorders. Hormonal dosage may need to be adjusted as a trans person ages, whilst maintaining a dose that sustains their affirmed gender (Mahan et al, 2016;Gooren and T'Sjoen, 2018). Conditions associated with ageing may add to the complexity of treatment (Ferron et al, 2010;Bachmann and Mussman, 2015) and may introduce the possibility of drug interactions with hormonal treatments (Porter et al, 2016).…”

“…Conditions associated with ageing may add to the complexity of treatment (Ferron et al, 2010;Bachmann and Mussman, 2015) and may introduce the possibility of drug interactions with hormonal treatments (Porter et al, 2016). Bone health is a further area of concern in older trans individuals as a consequence of long-term hormone treatment (Mahan et al, 2016).…”

Gay and Gray Vii: a Multidisciplinary Approach to Transgender Aging

“…Older adults also have lower testosterone and estrogen levels at baseline, which will impact the dosage of hormones needed for transition. 53 (2) Surgeon: Not all transgender people want surgery, but many do. 43 As noted above, surgeries that assist with transition are called gender-affirming surgery or gender-confirmation surgery because it affirms that person's already existing gender identity.…”

Supporting Aged Care Workers to Understand and Respond to the Needs of Trans and Gender Diverse People: An Australian Co-designed Quality Improvement Initiative

“…Other common issues for trans older people are pharmacological management (e.g. interactions between hormone and other pharmacological treatments, underdosing, overdosing, cost of hormone treatment) and fears about end of life care and/or dementia, particularly around decision-making [10,11].…”