Hayes-Lattin Madison, Krivicich Laura M, Bragg Jack T, Rogerson Ashley, Salzler Matthew J
Tufts University School of Medicine, Boston, Massachusetts, USA.
Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, USA.
Br J Sports Med. 2024 Sep 9;58(18):1075-1082. doi: 10.1136/bjsports-2023-107703.
Orthopaedic and sports medicine clinicians can improve outcomes for transgender patients by understanding the physiological effects of gender-affirming hormone therapy (GAHT). This narrative review investigated the role of GAHT on bone mineral density, fracture risk, thromboembolic risk, cardiovascular health and ligament/tendon injury in this population. A search from the PubMed database using relevant terms was performed. Studies were included if they were levels 1-3 evidence. Due to the paucity of studies on ligament and tendon injury risk in transgender patients, levels 1-3 evidence on the effects of sex hormones in cisgender patients as well as basic science studies were included for these two topics. This review found that transgender patients on GAHT have an elevated fracture risk, but GAHT has beneficial effects on bone mineral density in transgender women. Transgender women on GAHT also have an increased risk of venous thromboembolism, stroke and myocardial infarction compared with cisgender women. Despite these elevated risks, studies have found it is safe to continue GAHT perioperatively for both transgender women and men undergoing low-risk operations. Orthopaedic and sports medicine clinicians should understand these unique health considerations for equitable patient care.
骨科和运动医学临床医生可以通过了解性别确认激素疗法（GAHT）的生理影响来改善跨性别患者的治疗效果。这篇叙述性综述调查了GAHT在该人群中对骨密度、骨折风险、血栓栓塞风险、心血管健康以及韧带/肌腱损伤的作用。使用相关术语在PubMed数据库中进行了检索。纳入的研究需为1-3级证据。由于关于跨性别患者韧带和肌腱损伤风险的研究较少，因此这两个主题纳入了1-3级关于性激素对顺性别患者影响的证据以及基础科学研究。该综述发现，接受GAHT的跨性别患者骨折风险升高，但GAHT对跨性别女性的骨密度有有益影响。与顺性别女性相比，接受GAHT的跨性别女性发生静脉血栓栓塞、中风和心肌梗死的风险也更高。尽管存在这些较高风险，但研究发现，对于接受低风险手术的跨性别女性和男性，围手术期继续使用GAHT是安全的。骨科和运动医学临床医生应了解这些独特的健康因素，以便为患者提供公平的治疗。
