Study finds hormone therapy in transgender adults safe

In the most comprehensive review to date addressing the relative safety of hormone therapy for transgender persons, researchers from Boston University School of Medicine (BUSM) have found that hormone therapy in transgender adults is safe. The findings, which appear in the Journal of Clinical and Translational Endocrinology, may help reduce the barriers for transgender individuals to receive medical care.

Transgender is an umbrella term for individuals whose gender identity, gender expression or behavior does not conform to that typically associated with the sex to which they were assigned at birth. It is difficult to accurately estimate the number of transgender people mostly because there are no population studies that accurately and completely account for the range of gender identity and gender expression. Access to healthcare for transgender individuals is limited, and some providers report concern for the safety of hormone therapy (HT) for transgender individuals.

BUSM researchers conducted a medical literature search and reviewed articles for evidence of medical problems arising from hormone treatment in transgender individuals. While increased risk of blood clots was seen among male to female transgender individuals and increased blood counts were seen in female to male transgender individuals, there was little evidence of other serious health concerns from the hormones including no increase in cancer prevalence or mortality due to transgender hormone therapy.

According to the researchers among the concerns raised in treating transgender individuals is the fear that hormone treatment will expose them to risks of disease that might be excessive and unacceptable. However, research to date does not support that fear. "Although many of the studies identified were small and will need to be replicated with larger numbers of patients involved, the overall trend of the findings is reassuring, explained corresponding author Joshua D. Safer, MD, FACP, associate professor of medicine and molecular medicine at BUSM. "Notably, there was no evidence of a significant increase in cancer risk from transgender hormone treatment despite that being a common fear that is actually listed in most current guidelines," he added.

Safer believes the findings may provide some reassurance to all individuals requiring hormone treatments. "Although the review uncovers numerous areas in transgender hormone treatment that require more research, it should already help put to rest unnecessary anxiety about hormone safety for transgender individuals. Thus, one additional barrier to care for transgender individuals can be substantially reduced relative to what is still thought by many," said Safer who is also an endocrinologist at Boston Medical Center.