Feminizing gender-affirming hormone therapy for the transgender and gender diverse population: An overview of treatment modality, monitoring, and risks

Aims: Feminizing gender-affirming hormone therapy (GAHT) can be utilized to help transfeminine transgender and gender diverse (TGD) individuals achieve the transformation of outward sex characteristics, thereby leading to improvements in psychological and social well-being. In this narrative review, we aim to summarize current guidelines for feminizing GAHT management as well as the available literature describing the associated health risks pertaining to cardiovascular disease, thromboembolic disease, bone health, and cancer risks.

Methods: Relevant literature from January 2019 through July 2022 pertaining to feminizing GAHT was identified using PubMed, Cochrane Library, EMBASE, and MEDLINE. A narrative summary was performed with the inclusion of more recently published guidance from the World Professional Association for Transgender Health, Standards of Care Version 8.

Results: Guidance regarding the prescribing of feminizing GAHT with estrogen, antiandrogen, and progesterone medications is summarized along with considerations of the cardiovascular, thromboembolic, bone health, and cancer risks associated with these therapies.

Conclusions: Feminizing GAHT is a highly effective method for transfeminine TGD patients to achieve medically necessary changes in secondary sex characteristics. Knowledge of the health risks of feminizing GAHT is largely drawn from research in the cisgender population, with a growing body of literature in TGD-specific patient populations. Feminizing GAHT appears to carry a low risk profile for most patients; however, further research describing the risks of hormone management around the time of gender-affirming surgery and in the aging TGD population is needed to optimize GAHT in the context of the evolving health risks over a TGD patient's lifespan.