Gender-affirming hormone therapy in cystic fibrosis – A case of new Pseudomonas infection

Shaffer, Lauren; Bozkanat, Melike; Lau, May; Sharma, Preeti; Sathe, Meghana; López, Ximena; Jain, Raksha

doi:10.1016/j.rmcr.2021.101353

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…The introduction of a standard oral contraceptive pill combining estrogen and progesterone was associated with an improvement in proinflammatory cytokines (IL-8, TNF-α, neutrophil elastase). Recently, Shaffer et al described an association between estrogen therapy and first PA isolation in an 18-year-old affirmed woman (transgender) despite improvement in lung function with the CFTR modulator (58). Estrogen level seems to act on survival rates in CF by modifying PA physiology.…”

Section: Microbiome Hormones and Immune System: A Balanced Trianglementioning

confidence: 99%

The Human Microbiome, an Emerging Key-Player in the Sex Gap in Respiratory Diseases

2021

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The sex gap is well-documented in respiratory diseases such as cystic fibrosis and chronic obstructive pulmonary disease. While the differences between males and females in prevalence, severity and prognosis are well-established, the pathophysiology of the sex difference has been poorly characterized to date. Over the past 10 years, metagenomics-based studies have revealed the presence of a resident microbiome in the respiratory tract and its central role in respiratory disease. The lung microbiome is associated with host immune response and health outcomes in both animal models and patient cohorts. The study of the lung microbiome is therefore an interesting new avenue to explore in order to understand the sex gap observed in respiratory diseases. Another important parameter to consider is the gut-lung axis, since the gut microbiome plays a crucial role in distant immune modulation in respiratory diseases, and an intestinal “microgenderome” has been reported: i.e., sexual dimorphism in the gut microbiome. The microgenderome provides new pathophysiological clues, as it defines the interactions between microbiome, sex hormones, immunity and disease susceptibility. As research on the microbiome is increasing in volume and scope, the objective of this review was to describe the state-of-the-art on the sex gap in respiratory medicine (acute pulmonary infection and chronic lung disease) in the light of the microbiome, including evidence of local (lung) or distant (gut) contributions to the pathophysiology of these diseases.

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Section: Microbiome Hormones and Immune System: A Balanced Trianglementioning

confidence: 99%

The Human Microbiome, an Emerging Key-Player in the Sex Gap in Respiratory Diseases

2021

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“…LGBTQIAþ youth are also less likely to discuss their sexual identity with their healthcare provider which may impact the care they receive [42]. Within CF initial case reports suggest that transgender women have more frequent pulmonary exacerbations and an accelerated decline in lung function after initiation of hormone therapy [43,44]. However, a recent descriptive multicenter study of 30 transgender pwCF, including both men and women, did not find any significant health outcome differences with hormonal therapy [45].…”

Section: Sex and Sexual Gender Minorities (Lgbtqiar)mentioning

confidence: 99%

Health inequities in the modulator era

Palla,

Laguna

2023

Current Opinion in Pulmonary Medicine

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Purpose of review To discuss the existing health inequities in people with cystic fibrosis (CF) and how the recent development of cystic fibrosis transmembrane regulator (CFTR) modulators may impact these inequities. Recent findings People with CF (pwCF) from low socioeconomic status (SES) have more pulmonary exacerbations, worse nutritional status, lower pulmonary function, and an increased mortality rate with less access to lung transplantation. pwCF who identify as racial and ethnic minorities have earlier mortality, lower lung function, are less likely to be detected on newborn screening resulting in a delayed diagnosis, are underrepresented in clinic trials, and less likely to be eligible for a CFTR modulator. Female sex is associated with more pulmonary exacerbations and earlier mortality. Sexual gender minorities are a vulnerable population with worse health outcomes, and more research is needed in CF. CFTR modulators are inaccessible to low to middle-income countries due to significant cost burden. Summary People with CF from low SES, racial and ethnic minorities, female sex, and sexual gender minorities face health inequities. CFTR modulator use will further widen existing health inequities given the unequal access to modulators based on nonqualifying genetics and exorbitant cost restricting use both on an individual and global level.

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“… 34 Another case report of a transgender woman with CF reported the new appearance of Pseudomonas aeruginosa in sputum but relatively stable pulmonary function after 1 year of estrogen therapy. 35 These two case reports highlight a potential clinical concern of which providers taking care of TGGNB people with CF should be aware.…”

Section: Introductionmentioning

confidence: 95%

“…One case report of a transgender woman (assigned male at birth) with CF undergoing estrogen therapy found worsened lung function and increasing frequency of PEx after 1 year of estrogen therapy 34 . Another case report of a transgender woman with CF reported the new appearance of Pseudomonas aeruginosa in sputum but relatively stable pulmonary function after 1 year of estrogen therapy 35 . These two case reports highlight a potential clinical concern of which providers taking care of TGGNB people with CF should be aware.…”

Section: Introductionmentioning

confidence: 97%

Optimizing sexual and reproductive health across the lifespan in people with cystic fibrosis

West

Kazmerski

Taylor‐Cousar

et al. 2021

Pediatric Pulmonology

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With improved therapies, people with cystic fibrosis are living longer and healthier lives and increasingly have questions surrounding their sexual and reproductive health. This article will summarize the important issues of which providers should be aware during the lifespan of people with cystic fibrosis, including puberty, adulthood, and menopause.A wide range of sexual and reproductive health topics are addressed such as puberty, transgender and gender nonbinary identities, contraception, sexually transmitted infections, hypogonadism, sexual functioning, cyclical hemoptysis, and urinary incontinence. We discuss gaps in knowledge and current evidence as well as management strategies to optimize care. Our goal is to support providers to enable them to give comprehensive care throughout the lifespan of people with cystic fibrosis.

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Gender-affirming hormone therapy in cystic fibrosis – A case of new Pseudomonas infection

Cited by 4 publications

References 10 publications

The Human Microbiome, an Emerging Key-Player in the Sex Gap in Respiratory Diseases

The Human Microbiome, an Emerging Key-Player in the Sex Gap in Respiratory Diseases

Health inequities in the modulator era

Optimizing sexual and reproductive health across the lifespan in people with cystic fibrosis

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