Case series of trans women suggests HIV drug efavirenz may make oral estradiol less effective

Disclaimer: I am not a medical professional and this is not medical advice.

Transgender women face a highly elevated prevalence of HIV infection, with Becasen et al. (2019) estimating that 14% of trans women in the United States are HIV-positive. Trans women of color are disproportionately affected: 44% of black trans women and 26% of Hispanic/Latina trans women have HIV, compared to only 7% of white trans women. A recent case series reported in Transgender Health highlights one way in which HIV medications may interact with cross-sex hormone therapy and require changes in the HRT regimen used. Continue reading “Case series of trans women suggests HIV drug efavirenz may make oral estradiol less effective”

Should elderly trans women continue taking HRT?

Disclaimer: I am not a medical professional and this is not medical advice.

One question frequently asked by trans women pertains to whether they will continue to take cross-sex hormones throughout their lifetime, or whether this will be tapered off or discontinued once they reach an age at which most cis women experience menopause. For many trans women, this won’t become relevant to them for several decades, but for others, this is a more immediate question: Gooren & T’Sjoen (2018) note that hundreds of trans women at the VU University gender clinic in Amsterdam are now age 60 or older. Additionally, some trans women may first seek treatment at an age beyond that at which cis women typically experience menopause. The circumstances of aging trans women, who do not possess ovaries and may or may not still possess testes, are clearly different from those of postmenopausal cis women in regards to sex hormones and development. So what approach to HRT is recommended for this group? Continue reading “Should elderly trans women continue taking HRT?”

New data on trans women’s estradiol/estrone ratios for different routes of administration of HRT

Disclaimer: I am not a medical professional and this is not medical advice.

I’ve previously covered anecdotal reports from HRT provider Dr. Will Powers on the role of relative levels of different kinds of estrogens in producing effective physical feminization in trans women. Estrogen is not one thing; estradiol (E2), the most common estrogen used in trans women’s HRT, is just one kind. Another form of estrogen, estrone (E1), binds to estrogen receptors but is much weaker in its effects than estradiol, and excessive levels of estrone compared to estradiol can crowd out estradiol at these receptors, inhibiting its feminizing effects. However, lab tests for trans women’s estrogen levels often only measure estrogen as a whole, rather than estradiol and estrone separately. Because of this, what appear to be adequate levels of estrogen may in reality consist mostly of less effective estrone rather than estradiol. Continue reading “New data on trans women’s estradiol/estrone ratios for different routes of administration of HRT”

It gets better, and keeps getting better: More time spent transitioning is associated with greater body satisfaction

Evidence for the health benefits of medical transition in treating gender dysphoria and its various comorbidities is abundant. Dozens of studies have found that transitioning is associated with reductions in gender dysphoria, depression, anxiety, and suicidality, along with improvements in body image, body satisfaction, sexual functioning, and general functioning. Another recent meta-analysis confirmed that gender-confirming surgery is associated with an improved quality of life (Passos, Teixeira, & Almeida-Santos, 2019). Continue reading “It gets better, and keeps getting better: More time spent transitioning is associated with greater body satisfaction”

Further publications on BRCA1/2 variants and their impact on transitioning

Disclaimer: I am not a doctor and this is not medical advice.

Last year, I wrote about case studies of pathological BRCA1 and BRCA2 gene variants in trans people, and how clinicians take these mutations into account during transition treatment. While harmful BRCA mutations are best known for their effect of drastically increasing breast cancer and ovarian cancer risk in cisgender women, these variants represent a concern for transgender women as well, as transitioning with hormone therapy produces the growth of breast tissue considered histologically identical to that of cis women. Trans women can get breast cancer – UCSF Transgender Care has even published recommendations for when trans women should begin receiving regular mammograms – and having a harmful BRCA1/2 variant can increase their risk. (BRCA1/2 variants are also a concern for transgender men, who may still have breast tissue or ovaries, and even for cis men, who can face a higher risk of various cancers from these harmful variants as well.) Continue reading “Further publications on BRCA1/2 variants and their impact on transitioning”