Gender Affirming Hormone Therapy (GAHT) is increasingly recognized for its critical role in supporting transgender individuals, enhancing psychological well-being, and managing gender dysphoria. As GAHT shares similarities with menopausal hormone therapy, clinicians experienced in menopausal care are finding themselves well-equipped to administer and manage GAHT. A narrative review aims to delve into the intricacies of transgender health and address the long-term effects of GAHT, which are paramount in optimizing care across an individual's lifespan.

The Fundamentals of GAHT

GAHT, often administered lifelong, aims to align sex steroid levels with the individual's affirmed gender. For transgender people undergoing feminizing hormone therapy, this involves significant risks including venous thromboembolism, myocardial infarction, stroke, and osteoporosis, which are notably elevated when compared to their cisgender counterparts. Those undergoing masculinizing hormone therapy face increased risks of polycythemia and myocardial infarction, with pelvic pain also being a common yet poorly understood complaint.

Long-Term Health Management

Managing the health of transgender individuals on GAHT requires a proactive approach, particularly in mitigating cardiovascular risks and optimizing bone health. The review underscores the scarcity of research guiding GAHT in older adults, recommending a personalized, shared decision-making process to balance the benefits against potential adverse effects.

Key Research Findings:

• Cardiovascular Risks: Both masculinizing and feminizing hormone therapies are linked with potential cardiovascular risks. These risks necessitate rigorous screening and management strategies to prevent and mitigate long-term health issues.
• Bone Health Concerns: Particularly for those on feminizing hormone therapy, there is a notable risk of osteoporosis. Ensuring adequate intake of Vitamin D and calcium, along with routine physical activity, is advised to support bone density and reduce fracture risks.
• Venous Thromboembolism (VTE): Transgender women on estrogen therapy have an elevated risk of VTE. The choice between oral and transdermal estrogen requires careful consideration of the individual's specific health profile and risk factors.
• Aging Considerations: The aging transgender population may face unique health challenges that are not yet fully understood due to the lack of comprehensive studies. Continuous hormone therapy might be necessary to maintain quality of life and psychological well-being, yet the dosage and type might need adjustment as patients age.

Conclusion and Future Directions

This review highlights the necessity for clinicians to adopt a nuanced understanding of GAHT, recognizing its profound impact on the long-term health and well-being of transgender individuals. It calls for more extensive research to fill the current gaps in knowledge, particularly regarding the management of GAHT in older age and its implications on chronic conditions.

As the field evolves, healthcare providers must stay informed and adaptable, ensuring that their care strategies are both affirming and evidence-based, tailored to meet the diverse needs of the transgender community throughout their lifespan.