scholarly journals Monitoring Long-Term Cardiovascular Risk from Estrogen Use in Transgender Women - Evidence Update for Clinicians

2002 ◽  
Author(s):  
Keyword(s):  
Hormone Therapy ◽  
Female Gender ◽  
The United States ◽  
Transgender Women ◽  
Cardiovascular Risks ◽  
Psychological Benefits ◽  
Transgender People ◽  
New Information ◽  
Primary Care Clinicians

A PCORI-funded study provides new information for primary care clinicians about the need to monitor long-term cardiovascular risks in transgender women receiving hormone therapy. Approximately 1.4 million transgender people live in the United States. Many transgender women pursue medical transition with hormone therapy including estrogen to align their bodies with their female gender identity. Evidence suggests that medical transition confers significant psychological benefits including reduced depression, anxiety, and suicidality and improved quality of life. However, the risks of using estrogen, including cardiovascular risks, are not well understood. Recent evidence on these risks can help inform decisions and improve care for transgender women who are currently using or formerly used estrogen.

scholarly journals Estrogen Use and the Risk for Blood Clots and Strokes Among Transgender Women - Evidence Update for Transgender Women

2020 ◽  
Author(s):  
Keyword(s):  
Quality Of Life ◽  
Gender Identity ◽  
Hormone Therapy ◽  
Female Gender ◽  
Transgender Women ◽  
Heart Health ◽  
Blood Clots ◽  
Gender Affirmation

Some transgender women use estrogen as part of their hormone therapy for gender affirmation. Estrogen helps transgender women align their bodies with their female gender identity. Gender affirmation with hormone therapy has benefits such as improved quality of life and reduced depression, anxiety, and suicidal thoughts. However, estrogen use in transgender women may have long-term risks to heart health.

scholarly journals Muscle Strength in Transgender Women After Long-Term Hormone Therapy: A Cross-Sectional Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A792-A793
Author(s):  
Leonardo A M Alvares ◽  
Marcelo R Santos ◽  
Francis Ribeiro Souza ◽  
Lívia Marcela Santos ◽  
Henrique A Ramos ◽  
...  
Keyword(s):  
Motor Control ◽  
Muscle Strength ◽  
Hormone Therapy ◽  
Oxidation Mechanism ◽  
Cross Sectional Study ◽  
Transgender Women ◽  
The Body ◽  
Sectional Study ◽  
Cross Sectional

Abstract Introduction: Cisgender women (CW) are usually weaker than cisgender men (CM), but when the strength is expressed in relation to the body weight (BW) or fat free mass (FFM) it is observed that the difference disappears what suggests that the innate qualities of the muscle and its motor control mechanisms are similar in CW and CM. The effects of prior exposure to testosterone during puberty on the performance of transgender women (TW) undergoing physical effort are not well known. Objective: To evaluate muscular strength of TW in long-term gender affirming hormone therapy (GAHT). Methods: A cross-sectional study was carried out with 8 TW (average age of 34.0 yo, SD ±4.8), 8 CM and 8 CW matched by age and body mass index (BMI). All TW were non-gonadectomized subjects and were in estrogen plus cyproterone acetate therapy (average time of 15.6 years (SD ±8.7) of treatment). Mean total testosterone (ng/dL) levels of TW, CW and CM were 83.5, 20.5 and 480.5 at the time of the study, respectively. Hemoglobin levels of TW, CW and CM were 14,2 (range 13,5-14,9), 14,35 (range 12,8-14,7) and 15,35 (range 14,0-18,2), respectively BC was assessed by InBody 720. Handgrip strength tests were carried out using the Stoelting hand-held hydraulic dynamometer. Results: The mean maximum strength was 31,9 kg (SD±2.4) in TW, 29.2 kg (SD±4.4) in CW, and 47.5 (SD±8.6) in CM (TWvs.CW p=0.0743; TWxCM p<0.0018; CWvsCM p<0.001). Free fat mass (FFM) of TW was 55.56±6.88 kg, CW 38.98±4,09 kg, CM 64,98±6,29 kg (TWvsCW p<0,0001; TWvsCM p=0,024; CWvsCM p<0,0001). In the evaluation Median Strength/FFM, a mean of 0.54 was observed in the TW group, and 0.76 in the CW and CM (TWvsCW p=0.0157 and TWvsCM p=0.036, CWvsCM p>0.9999). Discussion: The expression of muscle strength/FFM is the same in CM and CW, which suggests that the innate quality of the muscles as well as their motor control is similar in these groups, as showed in many data in the literature. However, the analysis of this ratio in TW showed a significant lower rate than the other groups. Conclusion: After GAHT muscle strength of TW is equal of CW. There is a decrease in the functionality of the muscular unit in producing strength in this group of TWs since strength decreased disproportionately to muscle mass which leads us to believe that there are important functional changes in intracellular oxidation mechanism.

scholarly journals Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Kellan E Baker ◽  
Lisa M Wilson ◽  
Ritu Sharma ◽  
Vadim Dukhanin ◽  
Kristen McArthur ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hormone Therapy ◽  
Hormone Treatment ◽  
Small Sample ◽  
Psychological Benefits ◽  
Cross Sectional ◽  
Transgender People ◽  
Small Sample Sizes ◽  
Study Designs

Abstract We sought to systematically review the effect of gender-affirming hormone therapy on psychological outcomes among transgender people. We searched PubMed, Embase, and PsycINFO through June 10, 2020 for studies evaluating quality of life (QOL), depression, anxiety, and death by suicide in the context of gender-affirming hormone therapy among transgender people of any age. We excluded case studies and studies reporting on less than 3 months of follow-up. We included 20 studies reported in 22 publications. Fifteen were trials or prospective cohorts, one was a retrospective cohort, and 4 were cross-sectional. Seven assessed QOL, 12 assessed depression, 8 assessed anxiety, and 1 assessed death by suicide. Three studies included trans-feminine people only; 7 included trans-masculine people only, and 10 included both. Three studies focused on adolescents. Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety. Associations were similar across gender identity and age. Certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions. We could not draw any conclusions about death by suicide. Future studies should investigate the psychological benefits of hormone therapy among larger and more diverse groups of transgender people using study designs that more effectively isolate the effects of hormone treatment.

scholarly journals Cardiovascular Risk Factors in Transgender Women Undergoing Long-Term Gender-Affirming Hormone Therapy: A Cross-Sectional Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A788-A789
Author(s):  
Leonardo A M Alvares ◽  
Lívia M Santos ◽  
Henrique A Ramos ◽  
Larissa G Rodeghel ◽  
Nathan B Cavenaghi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Hormone Therapy ◽  
Cross Sectional Study ◽  
Transgender Women ◽  
Activity Level ◽  
Sectional Study ◽  
Cross Sectional ◽  
Statistical Point

Abstract Introduction: Few data of long-term outcomes of cardiovascular (CVRF) risk factors of transgender women (TW) undergoing gender-affirming hormone therapy (GAHT) are available. Objectives: Evaluate CV risk factors after long-term GAHT in TW. Methods: A cross-sectional study was carried out with 8 TW (average age of 34.0 ±4.8 yo), 8 matched CM and 8 CW on age, body mass index (BMI) and activity level. All TW were non-gonadectomized subjects and were in estrogen [(E); transdermal estradiol (n=2), oral estradiol (n=3) and conjugated estrogen (n=3)] plus cyproterone acetate (CA) (n=8) therapy in an average time of 15.6 ±8.7 years. Results: Total Testosterone (ng/dL) level of TW, CW and CM were 83,5 (range 12,0-637,0), 20,5 (range 12,0-41,0) and 480,5 (range 264,0-843,0), respectively. It was similar between TW and CW (p=0,7284) and different in the comparison TWvsCM (p=0,0325). In TW group, the median of blood glucose was 84 mg / dL, HBA1c 5.1%, total cholesterol 146 mg / dL, HDLc 43 mg / dL, LDLc 89 mg / dL and triglycerides 81.5 mg / dL. In the comparison with other groups, there was no difference from the statistical point of view. It is necessary to emphasize the HDLc of TW (43 mg/dL) which was exactly the same of CM (p>0,999) and lower than CW (60 mg/dL)(p=0,0720). Systolic Blood Pressure (SBP)(mmHg) of TW (126±13) was higher than that of CW (95±11;p<0.001) and equal to that of CM (115±9;p=0.1489). Regards Diastolic Blood Pressure (DBP) (mmHg), the medians of TW, CW and CM were 80, 60 and 80, respectively, and in the comparison TWxCW p = 0.0070 and TWxCM p> 0.9999. Discussion: Youth TW (16.3 ± 1.4 yo) taking an average estradiol dose of 1.5 ± 1.0 mg/day, with an average AGHT duration of 12.3 ± 9.9 months matched to controls on age and BMI did have higher HDL than CW and TW participants were more insulin resistant than CM. About SBP of that youth TW (107 ± 12), it was lower than CW 113 ± 7 (p>0,05) and CM 116 ± 8 (p<0,001). Other previous study showed that after 6 months of estradiol use, in doses ranging from 2 to 8 mg daily glucose enhanced 6 mg/dL (from 86 to 92) as well as TC from 170 to 178 mg/dL, HDLc from 50 to 54 mg/dL, TGL from 102 to 115 mg/dL, and LDL did not change (93), while a systematic review and meta-analysis showed increased only in TG levels. SBP and DBP increased on average of 7,2 mmHg and 5,7 mmHg, respectively. Conclusion: Metabolic findings observed after the first few months of TW GAHT appear to remain at long term, except for HDLc. SBP and DBP appear to increase in the long term, after a drop initially observed.

Identification of Transgender People With Cancer in Electronic Health Records: Recommendations Based on CancerLinQ Observations

2021 ◽  
Vol 17 (3) ◽  
pp. e336-e342
Author(s):  
Ash B. Alpert ◽  
George A. Komatsoulis ◽  
Stephen C. Meersman ◽  
Elizabeth Garrett-Mayer ◽  
Suanna S. Bruinooge ◽  
...  
Keyword(s):  
Gender Identity ◽  
Electronic Health Records ◽  
Total Population ◽  
Female Gender ◽  
The United States ◽  
Current Data ◽  
Health Records ◽  
Transgender People ◽  
Transgender Identity ◽  
Electronic Health

PURPOSE: Cancer prevalence and outcomes data, necessary to understand disparities in transgender populations, are significantly hampered because gender identity data are not routinely collected. A database of clinical data on people with cancer, CancerLinQ, is operated by the ASCO and collected from practices across the United States and multiple electronic health records. METHODS: To attempt to identify transgender people with cancer within CancerLinQ, we used three criteria: (1) International Classification of Diseases 9/10 diagnosis (Dx) code suggestive of transgender identity; (2) male gender and Dx of cervical, endometrial, ovarian, fallopian tube, or other related cancer; and (3) female gender and Dx of prostate, testicular, penile, or other related cancer. Charts were abstracted to confirm transgender identity. RESULTS: Five hundred fifty-seven cases matched inclusion criteria and two hundred and forty-two were abstracted. Seventy-six percent of patients with Dx codes suggestive of transgender identity were transgender. Only 2% and 3% of the people identified by criteria 2 and 3 had evidence of transgender identity, respectively. Extrapolating to nonabstracted data, we would expect to identify an additional four individuals in category 2 and an additional three individuals in category 3, or a total of 44. The total population in CancerLinQ is approximately 1,300,000. Thus, our methods could identify 0.003% of the total population as transgender. CONCLUSION: Given the need for data regarding transgender people with cancer and the deficiencies of current data resources, a national concerted effort is needed to prospectively collect gender identity data. These efforts will require systemic efforts to create safe healthcare environments for transgender people.

scholarly journals Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men

2021 ◽  
Author(s):  
Jason O. van Heesewijk ◽  
Koen M.A. Dreijerink ◽  
Chantal M. Wiepjes ◽  
Almar A.L. Kok ◽  
Natasja M. van Schoor ◽  
...  
Keyword(s):  
Cognitive Functioning ◽  
Hormone Therapy ◽  
Transgender Women

scholarly journals Hemodialysis vascular access morbidity.

1996 ◽  
Vol 7 (4) ◽  
pp. 523-535
Author(s):  
H I Feldman ◽  
S Kobrin ◽  
A Wasserstein
Keyword(s):  
United States ◽  
Vascular Access ◽  
The United States ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Arteriovenous Fistulae ◽  
New Information ◽  
Hemodialysis Vascular Access ◽  
Changing Patterns

Complications associated with hemodialysis vascular access represent one of the most important sources of morbidity among ESRD patients in the United States today. In this study, new data on the magnitude and growth of vascular access-related hospitalization in the United States is presented, demonstrating that the costs of this morbidity will soon exceed $1 billion per yr. This study also reviews published literature on the morbidity associated specifically with native arteriovenous fistulae, polytetrafluoroethylene bridge grafts, and permanent central venous catheters. Next, new information on the changing patterns of vascular access type in the United States is presented, demonstrating the continuing evolution of medical practice away from the use of arteriovenous fistulae in favor of more reliance on synthetic bridge grafts. Based on these data, a discussion is provided of the tradeoffs among the most commonly available modalities of vascular access today. Although radial arteriovenous fistulae continue to represent the optimal access modality, the appropriate roles for brachial arteriovenous fistulae, synthetic bridge grafts, and central venous catheters are less certain because of inadequate data on the long-term function of the first and the high rates of complications associated with the latter two. To reduce vascular access-related morbidity, strategies must be developed not only to prevent and detect appropriately early synthetic vascular access dysfunction, but to better identify the patients in a whom radial arteriovenous fistula is a viable clinical option.

The Role of Early Wins in Long-Term Success

2015 ◽  
pp. 95-99
Author(s):  
Frederick S. Johnson
Keyword(s):  
Public Health ◽  
The United States ◽  
Federal Agencies ◽  
Community Members ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

scholarly journals Electronic Cigarettes, Vaping, and Lung Disease: A Short Primer

2020 ◽  
Vol 15 (4) ◽  
pp. 24-27
Author(s):  
Max Deschner ◽  
Marcel Tunks ◽  
Cory Yamashita
Keyword(s):  
Lung Disease ◽  
Electronic Cigarettes ◽  
The United States ◽  
Long Term Effects ◽  
The Public ◽  
Canadian Youth ◽  
New Information ◽  
Nous Examinons ◽  
Sevrage Tabagique

In recent years there has been a proliferation in the practice of vaping to consume nicotine-and cannabis-based products. While evidence on the benefits and risks of electronic cigarettes (e-cigarettes) is evolving, this brief primer highlights important new information about vaping for clinicians, researchers and the public. In 2018, the Canadian government passed legislation to regulate tobacco and vaping products. We discuss evidence comparing e-cigarettes versus nicotine replacement therapy for smoking cessation and highlight limitations of this body of research. While e-cigarettes are felt to contain fewer toxins than cigarettes, the long-term effects of vaping remain unknown. Emerging data demonstrates associations between vaping and acute and chronic lung disease. We discuss the emergence of an outbreak of severe lung injury associated with e-cigarette use in the United States and similar cases in Canada. Finally, we review evidence demonstrating the growing prevalence of vaping and smoking amongst Canadian youth. RESUMECes dernières années, on a assisté à une prolifération de la pratique de la vaporisation pour consommer des produits à base de nicotine et de cannabis. Alors que les preuves sur les avantages et les risques des cigarettes électroniques (e-cigarettes) évoluent, ce bref aperçu met en lumière de nouvelles informations importantes sur le vaping pour les cliniciens, les chercheurs et le public. En 2018, le gouvernement canadien a adopté une loi pour réglementer les produits du tabac et les produits à base de vapeur. Nous examinons les données comparant les e-cigarettes et les thérapies de remplacement de la nicotine pour le sevrage tabagique et soulignons les limites de ce corpus de recherche. Bien que l’on estime que les e-cigarettes contiennent moins de toxines que les cigarettes, les effets à long terme des vapeurs restent inconnus. Les données émergentes démontrent des associations entre l’inhalation de vapeurs et les maladies pulmonaires aiguës et chroniques. Nous discutons de l’émergence d’une épidémie de lésions pulmonaires graves associées à l’utilisation des e-cigarettes aux États-Unis et de cas similaires au Canada. Enfin, nous passons en revue les preuves démontrant la prévalence croissante des vapeurs et du tabagisme chez les jeunes Canadiens.

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