Rowniak Stefan, Bolt Lindsay, Sharifi Claire
School of Nursing and Health Professionals, University of San Francisco, San Francisco, USA.
Institute for Nursing Excellence, University of California, San Francisco (UCSF) Health, San Francisco, USA.
JBI Database System Rev Implement Rep. 2019 Sep;17(9):1826-1854. doi: 10.11124/JBISRIR-2017-003869.
The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in transgender individuals.
Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related-care in their office or clinic.
Eligible studies included participants who were transgender (trans) women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety.
A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and gray literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the JBI protocols, standardized critical appraisal and data extraction tools.
Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred.
Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but had not yet begun taking cross-sex hormones. However, because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made. High-quality research on this issue is needed, as is the development of a quality-of-life tool specific to the transgender population.
本综述的目的是评估跨性别激素的使用在改善跨性别者生活质量以及抑郁和焦虑相关指标方面的有效性。
跨性别医学作为一个专业领域仍处于起步阶段，开始吸引越来越多的初级保健提供者。使用激素辅助性别转换有望改善生活质量，但高质量研究较少。之前发现了两项系统综述。一项综述纳入了参与者接受性别确认手术的研究，另一项综述仅考虑前瞻性研究。尽管缺乏高质量研究，但两项综述均发现激素使用有好处。为了具体描述与激素治疗相关的结果，本综述聚焦于尚未接受手术干预的患者，旨在为考虑在其办公室或诊所提供性别转换相关护理的初级保健提供者提供信息。
符合条件的研究包括跨性别（trans）女性、跨性别男性或不认同二元性别且正在使用跨性别激素的参与者。本综述仅考虑激素使用在医学监督下的研究。纳入了已经接受任何形式性别确认手术的参与者的研究被排除，未使用经过验证的工具来测量生活质量、抑郁或焦虑的研究也被排除。
2017年8月和9月对PubMed、CINAHL、Embase和PsycINFO进行了全面的数据库检索。对未发表研究和灰色文献的检索包括谷歌、纽约医学科学院和世界跨性别健康专业协会（WPATH）会议论文集。检索的任何部分均未设置日期限制。由两名独立评审员使用JBI协议、标准化批判性评价和数据提取工具进行研究选择、批判性评价和数据提取。
七项观察性研究符合本综述的纳入标准。所有纳入研究中的跨性别参与者总数为552人。各研究中的样本量从14人到163人不等。总体而言，由于不精确性和间接性问题，研究结果的确定性为低到极低。使用跨性别激素与生活质量、抑郁和焦虑评分的改善相关，尽管无法推断因果关系。
与已登记到性别重置诊所但尚未开始使用跨性别激素的跨性别者相比，接受跨性别激素处方的跨性别参与者在测量生活质量、焦虑和抑郁的经过验证的量表上的得分有统计学意义的改善。然而，由于该证据的确定性为极低到低，因此无法就使用激素改善生活质量、抑郁和焦虑提出建议。需要针对此问题开展高质量研究，以及开发专门针对跨性别群体的生活质量工具。
