Lieke Galas1, Joost Derwig2, Marian Spath3, Renate van Genugten1, Henri Timmers4, Hedi Claahsen-Van der Grinten5, Chris Verhaak2, Christa van Bunderen1
(1) Endocrinology, Center of Expertise on Sex and Gender, Radboudumc, Nijmegen, Nederland.
(2) Medical Psychology, Center of Expertise on Sex and Gender, Radboudumc, Nijmegen, Nederland.
(3) Gynaecology, Center of Expertise on Sex and Gender, Radboudumc, Nijmegen, Nederland.
(4) Endocrinology, Radboudumc, Nijmegen, Nederland.
(5) Pediatrics, Center of Expertise on Sex and Gender, Radboudumc, Nijmegen, Nederland.
Background
Gender-affirming hormone therapy (GAHT) is a well-studied medical intervention for alleviating gender dysphoria in transgender and gender diverse individuals (TGDs). However, limited access to supervised medical care increases the risk of unsupervised use of GAHT (uGAHT). Evidence of the influence of uGAHT on physical, mental, and reproductive health is seldomly studied. This study aims to describe mental and physical health in adult patients using uGAHT at baseline during the diagnostic evaluation within a specialized gender healthcare center.
Patients and methods
Patient records of 75 users of uGAHT and 547 treatment naive participants were included. Outcome measures include compared differences in hormone levels; fertility counseling and cryopreservation rates during the diagnostic period; duration of the diagnostic period, and mental and physical health scores indicated by the HADS and SF-36 questionnaires.
Results
Sex hormone levels among uGAHT users varied substantially; 28.6% and 25.5% had supraphysiological levels for masculinizing and feminizing GAHT respectively. Hematocrit levels exceeded 50% in 7.1% of testosterone users. Fertility counseling and cryopreservation rates during diagnostic period tended to be lower in uGAHT users (73.3%; 21.3%) compared to treatment naive patients (85.7%; 24.2%). Mental health as indicated by HADS and SF-36 self-reports was significantly better in uGAHT users.
Conclusion
uGAHT is a challenging and understudied topic in transgender healthcare. While uGAHT may alleviate psychological distress, it may also pose potential health risks by over- or underdosing hormones and creating missed opportunities for fertility preservation. More awareness of possible risks and consequences of uGAHT is warranted.