Division of Endocrinology, Metabolism & Diabetes, Department of Medicine, University of Colorado, Anschutz Medical Campus, 12801 E 17th Ave, Aurora, CO, 80045, USA.
Department of Endocrinology, Medicine Service, Rocky Mountain Regional Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, 80045, CO, USA.
J Gen Intern Med. 2021 May;36(5):1380-1389. doi: 10.1007/s11606-021-06634-7. Epub 2021 Feb 5.
Despite the growing number of adult transgender and gender diverse (TGD) patients seeking health services, there are many unknowns regarding how routine screening recommendations should be applied to TGD persons receiving gender-affirming hormone therapy (GAHT). Patients taking GAHT may have disease risks that differ from what is expected based on their sex assigned at birth or affirmed gender identity. We discuss two patient cases, one transgender man and one transgender woman who present for routine medical care, to review several conditions that may be impacted by the hormones utilized in masculinizing and feminizing GAHT and for which screening recommendations are available for TGD adults: cardiovascular risk factors, osteoporosis, breast cancer, cervical cancer, and prostate cancer. We reviewed the TGD-specific screening recommendations from several major medical organizations and programs and found them to be largely based upon expert opinion due to a lack of evidence. The goal of this narrative review is to assist healthcare professionals in counseling and screening their TGD patients when and where appropriate. Not all TGD adults have the ability or need to receive routine medical care from a specialized TGD health clinic; therefore, it is essential for all healthcare professionals involved in routine and gender-affirming care to have knowledge about these conditions and screenings.
尽管越来越多的成年跨性别和性别多样化（TGD）患者寻求医疗服务，但对于如何将常规筛查建议应用于接受性别肯定激素治疗（GAHT）的 TGD 患者，仍有许多未知之处。接受 GAHT 的患者可能存在与基于出生时分配的性别或确认的性别认同所预期的不同的疾病风险。我们讨论了两个患者病例，一个是跨性别男性，一个是跨性别女性，他们因常规医疗护理就诊，以回顾几种可能受到用于男性化和女性化 GAHT 的激素影响的疾病，以及针对 TGD 成年人的可用筛查建议：心血管危险因素、骨质疏松症、乳腺癌、宫颈癌和前列腺癌。我们回顾了几个主要医疗组织和项目的 TGD 特定筛查建议，发现它们主要基于专家意见，因为缺乏证据。本叙述性综述的目的是帮助医疗保健专业人员在适当的时候为 TGD 患者提供咨询和筛查。并非所有 TGD 成年人都有能力或需要从专门的 TGD 健康诊所获得常规医疗护理；因此，所有参与常规和性别肯定护理的医疗保健专业人员都必须了解这些疾病和筛查。
