Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia.
Department of Endocrinology, Austin Health, Heidelberg, Australia.
Climacteric. 2023 Jun;26(3):256-262. doi: 10.1080/13697137.2023.2176217. Epub 2023 Apr 3.
Gender affirming hormone therapy (GAHT) is used by many transgender people to reduce gender incongruence and improve psychological functioning. As GAHT shares many similarities with menopausal hormone therapy, clinicians supporting people through menopause are ideally placed to manage GAHT. This narrative review provides an overview of transgender health and discusses long-term effects of GAHT to consider when managing transgender individuals across the lifespan. Menopause is less relevant for transgender individuals who take GAHT (often given lifelong) to achieve sex steroid concentrations generally in the range of the affirmed gender. For people using feminizing hormone therapy, there is an elevated risk of venous thromboembolism, myocardial infarction, stroke and osteoporosis relative to cisgender individuals. For trans people using masculinizing hormone therapy, there is an increased risk of polycythemia, probable higher risk of myocardial infarction and pelvic pain which is poorly understood. Proactive mitigation of cardiovascular risk factors is important for all transgender people and optimization of bone health is important for those using feminizing hormones. With a lack of research to guide GAHT in older age, a shared decision-making approach is recommended for the provision of GAHT to achieve individual goals whilst minimizing potential adverse effects.
性别肯定激素治疗（GAHT）被许多跨性别者用于减少性别不一致和改善心理功能。由于 GAHT 与更年期激素治疗有许多相似之处，因此支持处于更年期的人的临床医生最适合管理 GAHT。本叙述性综述概述了跨性别者的健康状况，并讨论了 GAHT 的长期影响，以便在跨性别者的整个生命周期中进行管理。对于接受 GAHT（通常终生服用）以达到与所认同性别范围内的性激素浓度相似的跨性别者，更年期的相关性较低。对于使用女性化激素治疗的人，与顺性别者相比，静脉血栓栓塞、心肌梗死、中风和骨质疏松症的风险升高。对于使用男性化激素治疗的跨性别者，存在红细胞增多症的风险增加，可能存在更高的心肌梗死风险和骨盆疼痛，这一点尚未得到充分理解。积极缓解心血管危险因素对所有跨性别者都很重要，优化骨骼健康对使用女性化激素的人也很重要。由于缺乏研究来指导老年时期的 GAHT，建议采用共同决策方法来提供 GAHT，以实现个人目标，同时最大限度地减少潜在的不良影响。
