Hormone therapy for trans and gender diverse patients in the general practice setting

Cundill, Pauline

doi:10.31128/ajgp-01-20-5197

Cited by 22 publications

(23 citation statements)

References 13 publications

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“…Gender-affirming hormone therapy (GAHT), sometimes referred to as cross-sex hormone therapy, is commonly used among transgender individuals undergoing a medical transition, and also results in profound changes within the internal hormonal environment ( 178 ). With GAHT, people assigned male at birth who seek feminization receive exogenous estradiol, often alongside drugs with anti-androgenic effects.…”

Section: Immunological Transcriptome and Epigenome Differences Durimentioning

confidence: 99%

Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics

et al. 2021

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Sexual dimorphism refers to differences between biological sexes that extend beyond sexual characteristics. In humans, sexual dimorphism in the immune response has been well demonstrated, with females exhibiting lower infection rates than males for a variety of bacterial, viral, and parasitic pathogens. There is also a substantially increased incidence of autoimmune disease in females compared to males. Together, these trends indicate that females have a heightened immune reactogenicity to both self and non-self-molecular patterns. However, the molecular mechanisms driving the sexually dimorphic immune response are not fully understood. The female sex hormones estrogen and progesterone, as well as the male androgens, such as testosterone, elicit direct effects on the function and inflammatory capacity of immune cells. Several studies have identified a sex-specific transcriptome and methylome, independent of the well-described phenomenon of X-chromosome inactivation, suggesting that sexual dimorphism also occurs at the epigenetic level. Moreover, distinct alterations to the transcriptome and epigenetic landscape occur in synchrony with periods of hormonal change, such as puberty, pregnancy, menopause, and exogenous hormone therapy. These changes are also mirrored by changes in immune cell function. This review will outline the evidence for sex hormones and pregnancy-associated hormones as drivers of epigenetic change, and how this may contribute to the sexual dimorphism. Determining the effects of sex hormones on innate immune function is important for understanding sexually dimorphic autoimmune diseases, sex-specific responses to pathogens and vaccines, and how innate immunity is altered during periods of hormonal change (endogenous or exogenous).

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Section: Immunological Transcriptome and Epigenome Differences Durimentioning

confidence: 99%

Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics

et al. 2021

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“…Here, gender-affirming surgery (bilateral mastectomy or 'top surgery') appears to decrease the risk of developing breast cancer among transgender people who were born biologically female (Stone et al, 2018). Testosterone (testosterone undecanoate) is the most common gender-affirming hormone prescribed for people born biologically female who wish to transition to a more 'typically' male outward expression of gender (Cundill, 2020). Testosterone is associated with changes in body fat distribution which can result in smaller breast size and potentially lower risk of breast cancer (Glaser & Dimitrakakis, 2015).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Awareness and inclusion of gender diverse people across healthcare are of increasing importance to ensure equitable health access, experiences and outcomes as in many countries, there is a growing population and awareness of people who identify as transgender (Cundill, 2020). Transgender is a broad term referring to people who do not identify or conform to typical expressions, roles or behaviours associated with the male or female sex to which they were assigned at birth (American Psychological Association, 2018).…”

Section: Introductionmentioning

confidence: 99%

Culturally safe, high‐quality breast cancer screening for transgender people: A scoping review protocol

Peters

Ramsey

Kennedy

et al. 2021

Journal of Advanced Nursing

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Aim: To develop evidence-based recommendations for provision of culturally safe, high-quality services for breast cancer screening for transgender people. Design:The scoping review will follow the JBI methodological guidance for scoping reviews.Methods: A search using MEDLINE (PubMed), Embase (Ovid), Scopus, the Cochrane Library, including the Cochrane Methodology Register, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and the World Health Organization, Australia Government Department of Health and Google Scholar will be undertaken. The review will include people of any age and ethnicity defined in the source of evidence as transgender. The review will include individuals who have used gender-affirming interventions or not and sources of evidence that report information relevant to the provision of culturally safe, high-quality breast cancer screening services for transgender people. English language sources of evidence published from database inception with information from any country will be eligible for inclusion.Sources will be screened for inclusion by three independent reviewers. Results will be extracted using a purpose-built tool and presented in relation to the review questions and objective in the final report using tables, figures and corresponding narrative. Project funding was approved by the Australian Government Department of Health in June 2020.Discussion: There are a range of factors that impact on the equity of health access and outcomes for people who are not cisgender. Transgender people are at risk of breast cancer but there is relatively little evidence about how their risks may or may not differ substantially from cis-gendered individuals and little guidance for health providers to ensure inclusive, culturally safe, high-quality breast cancer screening services for both transgender males, transgender females and gender diverse people who may not identify as male or as female.Impact: It is important to provide culturally safe, high-quality services for breast cancer screening for transgender people. K E Y W O R D S breast neoplasms, delivery of health care, early detection of cancer, gender identify, hormones, nurses, quality of health care, transgender persons | 277 PETERS ET al.

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“…A few participants reported the use of OCPs for the enhancement of female features. Studies showed that the use of OCPs, in this case, may indicate a transgender tendency in males [40,41]. This low incidence is expected since homosexuality is still socially unacceptable and the lesbian, gay, bisexual, and transgender (LGBT) community in Jordan face a great deal of discrimination, and stigmatization, in spite of the fact that the country's laws ended the criminalization of homosexuality since 1951 [42].…”

Section: Question N %mentioning

confidence: 99%

Unforeseen uses of oral contraceptive pills: Exploratory study in Jordanian community pharmacies

et al. 2020

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Background The use of oral contraceptive pills (OCPs) as a birth control method is very common worldwide. OCPs have many other labeled non-contraceptive indications, and as a result there is an associated risk of improper use, as with any other medications. This study was designed to assess the unforeseen improper uses of OCPs observed by community pharmacists in Jordan. Method A cross-sectional study design was conducted using a self-administered survey. A convenience sample (n = 380) of Jordanian community pharmacists, were recruited through social media resources. The survey included multiple-choice and open-ended questions. Descriptive statistics and correlation analyses were completed using SPSS. Results More than half of the recruited pharmacists (55.3%) were female, and the mean age of the participants was 32.58 ± 9.94. The majority of the pharmacists (85%) had good knowledge about the non-contraceptive indications of OCPs. About 53% of them confirmed their exposure to cases of the improper use of OCPs. About 67.5% of the pharmacists who confirmed exposure to such cases, reported the topical use of OCPs for the enhancement of hair growth. Around 15% of those pharmacists stated that OCPs were used to give negative results for addictive drug screening tests. In the event that the pharmacists suspected improper use, more than 90% suggested they would refrain from dispensing the pills. Conclusion This study has spotlighted many unforeseen uses of OCPs in Jordan and highlighted the need for restricted national regulations on the monitoring of OCP prescription/selling patterns in Jordan by policymakers. Moreover, there is a need for the establishment of national educational programs for the Jordanian community regarding the safe proper use of OCPs.

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Hormone therapy for trans and gender diverse patients in the general practice setting

Cited by 22 publications

References 13 publications

Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics

Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics

Culturally safe, high‐quality breast cancer screening for transgender people: A scoping review protocol

Unforeseen uses of oral contraceptive pills: Exploratory study in Jordanian community pharmacies

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