Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management

healthtransgenderwomenkapak

AGING IN TRANSGENDER WOMEN

Bilge Akay Çolak1
Kübra Baki Erin2

1Kanuni Training and Research Hospital, Department of Gynecology and Obstetrics, Trabzon, Türkiye
2Kanuni Training and Research Hospital, Department of Gynecology and Obstetrics, Trabzon, Türkiye

Akay Çolak B, Baki Erin K. Aging in Transgender Women. Balsak D, Aksin Ş, eds. Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.37-44.

ABSTRACT

Aging is a natural process that leads to irreversible changes in individuals’ physical, psychological, social, and mental realms. The experience of aging is unique to each individual and influenced by various factors, such as genetics, environmental conditions, and personal circumstances. Although people often perceive aging as a biological phenomenon, it also encompasses significant social and psychological dimensions. The dual nature of aging affects not only an individual’s physical health but also their interactions with society, relationships, and overall quality of life. This inevitable process typically impacts individuals’ health, social relationships, and quality of life as they age.

However, the aging experience differs for each individual. Transgender individuals, in particular, may encounter additional challenges that cisgender individuals do not face. Throughout the aging process, transgender individuals often experience higher levels of violence, discrimination, and rejection in society, which can complicate and intensify their later years. This social exclusion can have negative effects on both physical and psychological health, increasing the need for additional support and healthcare services.

Older transgender women, in particular, may need to seek clinical care to maintain gender-affirming hormone therapy or to initiate new treatments. However, feminizing hormone treatments, which typically involve high doses of estrogen, can pose significant health risks, such as cardiovascular diseases, an increased risk of cancer, and bone health issues. These health risks become even more complex when combined with the natural changes associated with aging.

Moreover, the aging process can have profound effects on the mental health of transgender individuals. Social exclusion, isolation, and the fear of stigmatization make psychological issues such as depression and anxiety more common among older transgender individuals. These psychological issues can weaken their social connections and negatively impact their overall quality of life. A lack of social support and societal stigma further complicates the ability of transgender individuals to lead a dignified and stable life during the aging process.

Additionally, the limited availability of specialized health guidelines for older transgender individuals further hinders their access to healthcare. The prejudices they may encounter within the healthcare system can lead to gaps in treatment and misguidance. This highlights the need for further research and the development of health policies to better understand and address the challenges faced by aging transgender individuals.

This chapter examines the challenges encountered by transgender women in the aging process and evaluates international recommendations and solutions addressing these issues.

Keywords: Transgender persons; Aging; Menopause; Health services for transgender persons; Hormone replacement therapy

Referanslar

  1. Sinnard MT, Raines CR, Budge SL. The Association Between Geographic Location and Anxiety and Depression in Transgender Individuals: An Exploratory Study of an Online Sample. Transgend Health. 2016;1(1):181-186. [Crossref]  [PubMed]  [PMC]
  2. Courtin E, Knapp M. Social isolation, loneliness and health in old age: a scoping review. Health Soc Care Community. 2017;25(3):799-812. [Crossref]  [PubMed]
  3. Adan M, Scribani M, Tallman N, Wolf-Gould C, Campo-Engelstein L, Gadomski A. Worry and Wisdom: A Qualitative Study of Transgender Elders' Perspectives on Aging. Transgend Health. 2021;6(6):332-342. [Crossref]  [PubMed]  [PMC]
  4. Ettner R. Care of the elderly transgender patient. Curr Opin Endocrinol Diabetes Obes. 2013;20(6):580-584. [Crossref]  [PubMed]
  5. Dragon CN, Guerino P, Ewald E, Laffan AM. Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data. LGBT Health. 2017;4(6):404-411. [Crossref]  [PubMed]  [PMC]
  6. Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022;23(sup1):S1-S259. [Crossref]  [PubMed]  [PMC]
  7. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. [Crossref]  [PubMed]  [PMC]
  8. Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality. JAMA. 2017;318(10):927. [Crossref]  [PubMed]  [PMC]
  9. Iwamoto SJ, Defreyne J, Kaoutzanis C, Davies RD, Moreau KL, Rothman MS. Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults. Ther Adv Endocrinol Metab. 2023;14. [Crossref]  [PubMed]  [PMC]
  10. Cai X, Hughto JMW, Reisner SL, Pachankis JE, Levy BR. Benefit of Gender-Affirming Medical Treatment for Transgender Elders: Later-Life Alignment of Mind and Body. LGBT Health. 2019;6(1):34-39. [Crossref]  [PubMed]  [PMC]
  11. Mohamed S, Hunter MS. Transgender women's experiences and beliefs about hormone therapy through and beyond mid-age: An exploratory UK study. International Journal of Transgenderism. 2019;20(1):98-107. [Crossref]  [PubMed]  [PMC]
  12. Westwood S. Lesbian, gay, bisexual, transgender and queer (LGBTQ+) menopause: Literature review, knowledge gaps and research agenda. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine. Published online August 8,2024. [Crossref]  [PubMed]
  13. Tangpricha V, den Heijer M. Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol. 2017;5(4):291-300. [Crossref]  [PubMed]
  14. Nota NM, Wiepjes CM, de Blok CJM, Gooren LJG, Kreukels BPC, den Heijer M. Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy. Circulation. 2019;139(11):1461-1462. [Crossref]  [PubMed]
  15. Gooren LJ, T'Sjoen G. Endocrine treatment of aging transgender people. Rev Endocr Metab Disord. 2018;19(3):253- 262. [Crossref]  [PubMed]
  16. Mehta JM, Kanell S, Borowicz CEA, Fisher MA. Transgender patients and gender-affirming hormone therapy through the mid-life. Maturitas. 2024;189:108093. [Crossref]  [PubMed]
  17. Zucker R, Reisman T, Safer JD. Minimizing Venous Thromboembolism in Feminizing Hormone Therapy: Applying Lessons From Cisgender Women and Previous Data. Endocrine Practice. 2021;27(6):621-625. [Crossref]  [PubMed]
  18. Cheung AS, Nolan BJ, Zwickl S. Transgender health and the impact of aging and menopause. Climacteric. 2023;26(3):256-262. [Crossref]  [PubMed]
  19. Asscheman H, T'Sjoen G, Lemaire A, et al. Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: a review. Andrologia. 2014;46(7):791-795. [Crossref]  [PubMed]
  20. Glintborg D, Christensen LL, Andersen MS. Transgender healthcare: metabolic outcomes and cardiovascular risk. Diabetologia. 2024;67(11):2393-2403. [Crossref]  [PubMed]
  21. Berner AM, Atkinson SE. The implications of hormone treatment for cancer risk, screening and treatment in transgender individuals. Best Pract Res Clin Endocrinol Metab. 2024;38(5):101909. [Crossref]  [PubMed]
  22. Gooren LJ, van Trotsenburg MAA, Giltay EJ, van Diest PJ. Breast Cancer Development in Transsexual Subjects Receiving Cross-Sex Hormone Treatment. J Sex Med. 2013;10(12):3129-3134. [Crossref]  [PubMed]
  23. de Blok CJM, Wiepjes CM, Nota NM, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. Published online May 14, 2019:l1652. [Crossref]  [PubMed]  [PMC]
  24. Iwamoto SJ, Grimstad F, Irwig MS, Rothman MS. Routine Screening for Transgender and Gender Diverse Adults Taking Gender-Affirming Hormone Therapy: a Narrative Review. J Gen Intern Med. 2021;36(5):1380-1389. [Crossref]  [PubMed]  [PMC]
  25. Parikh U, Mausner E, Chhor CM, Gao Y, Karrington I, Heller SL. Breast Imaging in Transgender Patients: What the Radiologist Should Know. RadioGraphics. 2020;40(1):13-27. [Crossref]  [PubMed]
  26. van Kesteren P, Meinhardt W, van der Valk P, Geldof A, Megens J, Gooren L. Effects of Estrogens Only on the Prostates of Aging Men. J Urol. Published online October 1996:1349- 1353. [Crossref]  [PubMed]
  27. de Nie I, de Blok CJM, van der Sluis TM, et al. Prostate Cancer Incidence under Androgen Deprivation: Nationwide Cohort Study in Trans Women Receiving Hormone Treatment. J Clin Endocrinol Metab. 2020;105(9):e3293-e3299. [Crossref]  [PubMed]  [PMC]
  28. Bertoncelli Tanaka M, Sahota K, Burn J, et al. Prostate cancer in transgender women: what does a urologist need to know? BJU Int. 2022;129(1):113-122. [Crossref]  [PubMed]
  29. Nik-Ahd F, Jarjour A, Figueiredo J, et al. Prostate-Specific Antigen Screening in Transgender Patients. Eur Urol.2023;83(1):48-54. [Crossref]  [PubMed]
  30. Crowley F, Mihalopoulos M, Gaglani S, et al. Prostate cancer in transgender women: considerations for screening, diagnosis and management. Br J Cancer. 2023;128(2):177-189. [Crossref]  [PubMed]  [PMC]
  31. Balcerek MI, Hovelroud R, Ruhl M, Nolan BJ. Giant Intracranial Meningiomas Requiring Surgery in 2 Transgender Women Treated With Cyproterone Acetate. JCEM CaseReports. 2024;2(10). [Crossref]  [PubMed]  [PMC]
  32. Defreyne J, Nota N, Pereira C, et al. Transient Elevated Serum Prolactin in Trans Women Is Caused by Cyproterone Acetate Treatment. LGBT Health. 2017;4(5):328-336. [Crossref]  [PubMed]
  33. Rothman MS, Iwamoto SJ. Bone Health in the Transgender Population. Clin Rev Bone Miner Metab. 2019;17(2):77-85. [Crossref]  [PubMed]  [PMC]
  34. Singh-Ospina N, Maraka S, Rodriguez-Gutierrez R, et al. Effect of Sex Steroids on the Bone Health of Transgender Individuals: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab. 2017;102(11):3904-3913. [Crossref]  [PubMed]
  35. Wiepjes CM, de Blok CJ, Staphorsius AS, et al. Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study. Journal of Bone and Mineral Research.2020;35(1):64-70. [Crossref]  [PubMed]  [PMC]
  36. Hammond I, Lentle B, van den Berg L, Vitols-McKay M. Gender Identity and Bone Densitometry. Canadian Association of Radiologists Journal. 2017;68(3):267-269. [Crossref]  [PubMed]
  37. Fredriksen-Goldsen KI, Cook-Daniels L, Kim HJ, et al. Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population. Gerontologist. 2014;54(3):488-500. [Crossref]  [PubMed]  [PMC]
  38. Johnson K, Yarns BC, Abrams JM, Calbridge LA, Sewell DD. Gay and Gray Session: An Interdisciplinary Approach to Transgender Aging. The American Journal of Geriatric Psychiatry. 2018;26(7):719-738. [Crossref]  [PubMed]
  39. Pellicane MJ, Ciesla JA. Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis. Clin Psychol Rev. 2022;91:102113. [Crossref]  [PubMed]
  40. Hoy-Ellis CP, Fredriksen-Goldsen KI. Depression Among Transgender Older Adults: General and Minority Stress. Am J Community Psychol. 2017;59(3-4):295-305. [Crossref]  [PubMed]  [PMC]
  41. Witcomb GL, Bouman WP, Claes L, Brewin N, Crawford JR, Arcelus J. Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services. J Affect Disord. 2018;235:308-315. [Crossref]  [PubMed]
  42. Baker KE, Wilson LM, Sharma R, Dukhanin V, McArthur K, Robinson KA. Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review. JEndocrSoc.2021;5(4). [Crossref]  [PubMed]  [PMC]
  43. Guo Y, Li Q, Yang X, et al. Prevalence of Alzheimer's and Related Dementia Diseases and Risk Factors Among Transgender Adults, Florida, 2012-2020. Am J Public Health. 2022;112(5):754-757. [Crossref]  [PubMed]  [PMC]
  44. van Heesewijk JO, Dreijerink KMA, Wiepjes CM, et al. LongTerm Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared with Cisgender Women and Men. J Sex Med. 2021;18(8):1434-1443. [Crossref]  [PubMed]
  45. Berkman C, Stein GL, Javier NM, O'Mahony S, Maingi S, Godfrey D. Disrespectful and inadequate palliative care to transgender persons. Palliat Support Care. 2024;22(1):3-9. [Crossref]  [PubMed]