Impact of hormones described in transgender rheumatology patients

The effect of gender-affirming hormone therapy on transgender patients with rheumatic disease is unclear, but does not appear to modulate the course and may not be strictly contraindicated in most patients, according to a case series and systematic literature search.



Dr Kristen Mathias

More doctors are practicing transgender medicine, but there is a limited amount of information available about rheumatic diseases in transgender and gender diverse (TGD) individuals, Kristen Mathias, MD, a rheumatologist at Johns Hopkins University, Baltimore, Maryland, said in her presentation of the study. at The Lancet Summit: Sex and gender in rheumatology.

“This is important because it is well known that sex hormones influence the pathogenesis and expression of autoimmune diseases,” Mathias said. Knowing more about the effects of sex-confirming hormone therapy (GAHT) and sex-confirming surgery on disease activity in TGGD individuals could better inform decisions about care in this population.

Mathias and colleagues identified 7 transgender patients with rheumatic diseases from a pool of 1,053 patients seen at Los Angeles County and University of Southern California Medical Center from June 2019 to June 2021. This included five transgender men and two transgender women. They ranged in age from 13 to 52 years.

All seven received GAHT and its impact on disease activity was considered “possible” in 2 of 7 patients.

In a systematic literature search, researchers found 11 studies involving 11 transgender women and 2 transgender men, ranging in age from 22 to 49 years. All patients were on GAHT. In 12 of the 13 patients, the hormones were believed to be possibly related to their rheumatic disease activity.

The 20 patients were diagnosed with rheumatoid arthritis, cutaneous and systemic lupus erythematosus, Still’s disease in adults, spondyloarthritis, myositis, and systemic sclerosis.

GAHT should not be a strict contraindication in these patients, based on these findings, Mathias noted. However, information to clarify the effect of GAHT on rheumatic diseases is scarce. Doctors should take a personalized, shared decision-making approach when consulting patients, she advised.

“During meetings with patients, they should be screened for psychosocial barriers if necessary,” Mathias advised.

Findings could pave the way for larger studies, more data

Studies on the impact and consequences of rheumatic disease in TGGD individuals are severely lacking, said Vagishwari Murugesan, MBBS, a clinical fellow in rheumatology at the University of Toronto, Canada.

“While this is a small study of just seven patients and no conclusive results can be drawn, studies like this could pave the way for larger multicenter studies, which could give us more definitive data on gender-affirming hormone therapy and its implications for rheumatic diseases. ” diseases,” said Murugesan, who was not involved in the study.

A registry would be a great way to collaborate with other stakeholders interested in the same topic and conduct larger studies, she said. “I would recommend that we not only screen for psychosocial barriers, but be actively involved as a healthcare community in addressing how we can overcome the barriers for patients to access effective healthcare.”

No external funding has been obtained for the research.

The Lancet Summit: Gender and Gender in Rheumatology: Summary P.14. Presented on September 22, 2022.

Jennifer Lubell is a freelance medical writer based in the greater Washington, DC area.

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