Advertisement
Featured Article| Volume 19, ISSUE 3, 104526, March 2023

Primary Care Practice for Gender-Diverse Patients Using Gender-Affirming Hormone Therapy

Published:February 02, 2023DOI:https://doi.org/10.1016/j.nurpra.2022.104526

      Highlights

      • Health care providers are lacking knowledge about gender-affirming care.
      • Transgender and gender-diverse patients face health care barriers that impact their health and well-being.
      • Gender-affirming hormone therapy guidelines with monitoring parameters and care considerations for individuals ≥16 years old are reviewed
      • Primary care guidelines and resources for health care providers and transgender and gender-diverse patients are included.

      Abstract

      Transgender and gender-diverse individuals face discrimination, bias, stigma, socioeconomic barriers, lack of knowledgeable, and/or supportive gender-affirming health care across the nation. Many primary care providers have not been educated about gender-affirming hormone therapy and the health care considerations using these necessary hormones for patients ≥16 years old. This review highlights basic gender-affirming hormone therapy management with monitoring parameters and some common primary care practice applications for transgender and gender-diverse patients. Evidence-based guidelines, resources, and advocacy links are provided and in alignment with the latest version of the World Professional Association for Transgender Health Standards of Care.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Coleman E.
        • Radix A.E.
        • Bouman W.P.
        • et al.
        World Professional Association for Transgender Health. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.
        Int J Transgend Health. 2022; 23 (Published correction appears in Int J Transgend Health. 2022;23(suppl 1):S259): S1-S258https://doi.org/10.1080/26895269.2022.2100644
        • Edwards-Leeper L.
        • Feldman H.A.
        • Lash B.R.
        • Shumer D.E.
        • Tishelman A.C.
        Psychological profile of the first sample of transgender youth presenting for medical intervention in a U.S pediatric gender center.
        Psychol Sex Orientat Gen Divers. 2017; 4 (https://doi.org/10.1037sgd0000239): 374-382
        • Turban J.L.
        • Kraschel K.L.
        • Cohen I.G.
        Legislation to criminalize gender-affirming medical care for transgender youth.
        JAMA. 2021; 325: 2251-2252https://doi.org/10.1001/jama.2021.4483
        • Valentine S.
        • Shipherd J.
        A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States.
        Clin Psychol Rev. 2018; 66: 24-38https://doi.org/10.1016/j.cpr.2018.03.003
        • Tordoff D.
        • Wanta J.
        • Collin A.
        • Stepney C.
        • Inwards-Breland D.
        • Ahrens K.
        Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care.
        JAMA Netw Open. 2022; 5 (Published correction appears in JAMA Netw Open. 2022;5(7):e2229031)e220978https://doi.org/10.1001/jamanetworkopen.2022.0978
        • Herman J.
        • Flores A.
        • O’Neill K.
        Report from the Williams Institute. How Many Adults and Youth Identify as Transgender in the United States? June 2022.
      1. UCSF Gender Affirming Health Program, Department of Family and Community Medicine, University of California San Francisco.
        in: Deutsch M.B. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. 2nd edition. 2016 (June 17)
        https://transcare.ucsf.edu/guidelines
        Date accessed: November 29, 2022
        • Russo F.
        Policy: Where transgender is no longer a diagnosis: Denmark becomes the first country to declassify it as a mental disorder.
        (Sci Am Published online June 6, 2017)
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        Fifth Edition. American Psychiatric Association, 2022: 511-520 (Text Revision. 5th)
        • Grant J.
        • Mottet L.
        • Edward J.
        • Harrison J.
        • Herman J.
        • Keisling M.
        National Transgender Discrimination Survey, 2008-2009. Inter-university Consortium for Political and Social Research November 11.
        https://doi.org/10.3886/ICPSR37888
        Date: 2020
        Date accessed: November 29, 2022
        • Kuper L.E.
        • Mathews S.
        • Lau M.
        Baseline mental health and psychosocial functioning of transgender adolescents seeking gender-affirming hormone therapy.
        J Dev Behav Pediat. 2019; 40: 589-596https://doi.org/10.1097/DBP.0000000000000697
      2. The Trevor Project, National Survey on LGBTQ Youth Mental Health.
        • Rodriguez M.
        • Granda M.
        • Gonzalez V.
        Gender incongruence in no longer a mental disorder.
        J Ment Health Clin Psychol. 2018; 2: 6-8https://doi.org/10.29245/2578-2959/2018/5.1157
        • Hembree W.
        • Cohen-Kettenis P.
        • Gooren L.
        • et al.
        Endocrine treatment of gender dysphoric/gender-incongruent persons: an Endocrine Society Clinical Practice Guideline.
        Endocrine Society. Endocr Pract. 2017; 102: 3869-3903https://doi.org/10.1210/jc.2017-01658
        • Deutsch M.
        Overview of feminizing hormone therapy. Transgender Guidelines of Excellence June 17.
        • Glintborg D.
        • Sjoen G.
        • Ravn P.
        • Skvsage M.
        Management of endocrine disease: optimal feminizing hormone treatment in transgender people.
        Eur J Endocrinol. 2021; 185: R49-R63https://doi.org/10.3886/ICPSR37888
        • Cheung A.
        • Lim H.
        • Cook T.
        • et al.
        Approach to interpreting common laboratory pathology tests in transgender individuals.
        J Clin Endocrinol Metab. 2021; 106: 893-901https://doi.org/10.1210/clinem/dgaa546
        • Totaro M.
        • Palazzi S.
        • Chiara C.
        • et al.
        Risk of venous thromboembolism in transgender people undergoing hormone feminizing therapy: a prevalence meta-analysis and meta-regression study.
        Front Endocrinol (Lausanne). 2021; 12741866https://doi.org/10.3389/fendo.2021.741866
        • Kerrebrouck M.
        • Vantilborgh A.
        • Collet S.
        • T’Sjoen G.
        Thrombophilia and hormonal therapy in transgender persons: a literature review and case series.
        Int J Transgend Health. 2022; 23: 377-391https://doi.org/10.1080/26895269.2022.2025551
        • Champaloux S.
        • Tepper N.
        • Monsour M.
        • et al.
        Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke.
        Am J Obstet Gynecol. 2017; 216 (489489.e7): 489.e1-489.e7https://doi.org/10.1016/j.ajog.2016.12.019
        • Ahmad S.
        • Rosendale N.
        Sex and gender considerations in episodic migraine.
        Curr Pain Headache Rep. 2022; 26: 505-516https://doi.org/10.1007/s11916-022-01052-8
        • Hranilovich J.
        • Kaiser E.
        • Pace A.
        • Barber M.
        • Ziplow J.
        Headache in transgender and gender-diverse patients: a narrative review.
        Headache. 2021; 61: 1040-1050https://doi.org/10.1111/head.14171
        • Moravek M.B.
        • Kinnear H.M.
        • Georget J.
        • et al.
        Impact of exogenous testosterone on reproduction in transgender men.
        Endocrinology. 2020; 161: bqaa014https://doi.org/10.1370/afm.2473
        • Kanj R.
        • Conard L.
        • Corathers S.
        • Trotman G.
        Hormonal contraceptive choices in a clinic-based series of transgender adolescents and young adults.
        Int J Transgend. 2019; 1: 413-420https://doi.org/10.1080/15532739.2019.1631929
        • Adeleye A.J.
        • Cedars M.I.
        • Smith J.
        • Mok-Lin E.
        Ovarian stimulation for fertility preservation or family building in a cohort of transgender men.
        J Assist Reprod Genet. 2019; 36 (10/1007/210815-019-01558-y q): 2155-2161
        • de Nie I.
        • Meißner A.
        • Kostelijk E.H.
        • et al.
        Impaired semen quality in trans women: prevalence and determinants.
        Hum Reprod. 2020; 35: 1529-1536
        • Mancini I.
        • Alvisi S.
        • Gava G.
        Contraception across transgender.
        Int J Impot Res. 2021; 33: 710-719https://doi.org/10.1038/s41443-021-00412-z
        • Williams Institute
        Transgender people over four times more likely than cisgender people to be victims of violent crime. March. 2021;23.
        • Hardacker C.
        • Baccellieri A.
        • Mueller E.
        • et al.
        Bladder health experiences, perceptions and knowledge of sexual and gender minorities.
        Int J Environ Res Public Health. 2019; 16: 3170https://doi.org/10.3390/ijerph16173170
        • Tordoff D.
        • Wanta J.
        • Collin A.
        • Stepney C.
        • Inwards-Breland D.
        • Ahrens K.
        Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care.
        JAMA Netw Open. 2022; 5 (Published correction appears in JAMA Netw Open. 2022;5(7):e2229031)e220978https://doi.org/10.1001/jamanetworkopen.2022.0978
        • Sterling J.
        • Garcia M.
        Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model.
        Transl Androl Urol. 2020; 9: 2771-2785https://doi.org/10.21037/tau-20-954
        • Iwamoto S.
        • Grimstad F.
        • Irwig M.
        • Rothman M.
        Routine screening for transgender and gender diverse adults taking gender-affirming hormone therapy: a narrative review.
        J Gen Intern Med. 2021; 36: 1380-1389https://doi.org/10.1007/s11606-021-06634-7
        • de Blok C.
        • Wiepjes C.
        • Nota N.
        • van Engelen K.
        • Adank M.
        • Dreijerink K.
        Breast cancer risk in transgender people receiving hormone treatment; nationwide cohort study in the Netherlands.
        BMJ. 2019; 365: l1652https://doi.org/10.1136/bmj.11652
        • Bertoncelli Tanaka T.
        • Sahota K.
        • Burn J.
        • et al.
        Prostate cancer in transgender women: what does a urologist need to know?.
        Br J Urol. 2022; 129: 113-122https://doi.org/10.1111/bju.15521
        • Peitzmeier S.M.
        • Reisner S.L.
        • Harigopal P.
        • Potter J.
        Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: implications for cervical cancer screening.
        J Gen Intern Med. 2014; 29: 778-784
        • Kiran T.
        • Davie S.
        • Singh D.
        • et al.
        Cancer screening rates among transgender adults: cross-sectional analysis of primary care data.
        Can Fam Phys. 2019; 65: e30-e37
        • Curry S.J.
        • Krist A.H.
        • et al.
        • US Preventive Services Task Force
        Screening for cervical cancer: US Preventive Services Task Force Recommendation Statement.
        JAMA. 2018; 320: 674-686https://doi.org/10.1001/jama.2018.10897
        • Reisner S.
        • Deutsch M.
        • Peitzmeier S.
        • et al.
        Comparing clinician-collected and self collected tests for detecting high-risk HPV infection among female-to-male transgender adults. Patient-Centered Outcomes Research Institute (PCORI).
        (Published 2018)
        https://doi.org/10.25302/9.2018.CER.140312625
        Date accessed: November 29, 2022
        • Maza M.
        • Melendez M.
        • Herrera A.
        • et al.
        Cervical cancer screening with human papillomavirus self-sampling among transgender men in El Salvador.
        LGBT Health. 2020; 7: 174-181https://doi.org/10.1089/lgbt.2019.0202
        • Hines D.
        • Laury E.
        • Habermann B.
        They just don’t get me: a qualitative analysis of transgender women’s health care experiences and clinician interactions.
        J Assoc Nurses AIDS Care. 2019; 30: e82-e95https://doi.org/10.1097/JNC.0000000000000023
        • Valentine S.
        • Shipherd J.
        A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States.
        Clin Psychol Rev. 2018; 66: 24-38https://doi.org/10.1016/j.cpr.2018.03.003

      Biography

      Elke Zschaebitz, DNP, FNP-BC, is an assistant professor at Georgetown University School of Nursing, Washington, DC, and can be contacted at [email protected]

      Biography

      Afton Bradley, MSN, MSW, FNP, is VLPP:GAHT Program co-director, Richmond, VA.

      Biography

      Signey Olson, DNP, CNM, WHNP-BC, is an assistant professor at Georgetown University School of Nursing, Washington, DC.

      Biography

      Catherine Casey, MD, is an associate professor of family medicine, University of Virginia Health System, Charlottesville, VA.

      Biography

      Jacqueline Britz, MD, MSPH, is an assistant professor, clinician-researcher, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA.