Tuesday, May 08, 2018

Battling Articles

How safe is Cross-gender Hormone Therapy?

When I started CHT I was warned about all the dangers of going on hormones by my endo, WPATH Standard of Care advises about the risks of CHT and now there are two articles that are 180 degrees apart.
Transgender Women Are At Greater Risk For Heart Attacks And Strokes, But “There Are Still A Lot Of Question Marks”
We know that men and women have different cardiovascular issues—where do trans women fit in?
NewNowNext
By Dan Avery
May 1, 2018

New research is pointing to a possible link between cardiovascular disease and transgender women undergoing hormone replacement therapy.

Analysis of nearly two dozens studies incorporating 3,231 transfeminine patients found 139 deaths attributed to heart disease, as well as eight strokes, 14 heart attacks, and 56 incidents of deep vein thrombosis—considerably higher rates than in either cisgender women or men. The study also found transgender women taking estrogen had higher blood pressure and increased levels of triglycerides, high concentrations of which are a risk factor for stroke.
[…]
A separate European study comparing outcomes for transgender and cisgender patients in the Kaiser Permanente health care system found that transfeminine patients had an increased risk for stroke, deep vein thrombosis, and pulmonary embolism.
Meanwhile this article says the opposite,
Hormone Therapy for Transgender Patients Potentially Safer Than Previously Thought
MD Mag
By Jenna Payesko
May 2, 2018

A new study conducted by researchers at Mount Sinai Health System found that in a retrospective chart review of nearly 100 transgender (male to female) patients receiving feminizing hormone therapy, levels of prolactin did not rise—alleviating concern about the possibility of developing autonomous prolactinomas later in life.

This is the first study to measure prolactin levels in transgender patients receiving the standard feminizing hormone therapy regimen that’s used in the US. The study demonstrates that gender-affirming treatment for transgender individuals may be safer than initially thought.
[…]
“Our data suggests that there may be no significant rise in prolactin when transgender women are treated with estrogen and that it may be unnecessary to monitor prolactin in patients receiving this treatment,” lead author, Joshua Safer, MD, executive director, center for transgender medicine and surgery, Mount Sinai, said in a statement.
So take your choice… yes it is bad for us… no it is not bad for us…

I believe that it is bad for us… kind of. I believe that the is an increase in negative health effects but the good mental health effects outweighs the bad effects.



Meanwhile we still have healthcare access problems,
Healthcare Difficulties Persist for Transgender Americans, Despite Increased Insurance Access
WVTF NPR
By Brad Kuntner
May 7, 2018

As state lawmakers consider broadening healthcare access for lower-income people through expansion of the federal Medicaid program, transgender Virginians are sure to be among those who benefit.

But barriers, either from insurance providers or from the federal government, are still in place.

Katrina Cunningham is participating in a panel of transgender men and women at Diversity Richmond’s National Transgender HIV Awareness Day. Part fashion show, part learning opportunity, Cunningham recalls the earliest days of her transition, without healthcare and seeking treatment anywhere she could.
[…]
Lewis said there’s a myriad of reasons trans people can be denied coverage, and its often the result of not understanding the medical needs they deal with daily.  “Insurance companies say that these are cosmetic procedures even though they are recognized to treat gender dysphoria.”
I advise trans people if they get denied coverage to try calling back again to get a different customer assistant operator, sometimes that’s all it takes but most of the time it is a long drawn out process to get what we are due.

1 comment:

Anonymous said...

Hi Diana,
Thanks for bringing these to our attention but I do not think they are contrary. The first deals with risk of a cardiac and/or thrombotic event which was a risk to women in the days of higher estrogen concentrations used in oral contraceptives at the time and would still seem to be a risk for MTF HRT and one reason for monitoring levels.

The second paper specifically focuses on the risk of a prolactinoma which is probably totally unrelated to the cardiovascular risks explored in the first and which fortunately seems to be a theoretical rather than real risk.

However, a clot, stroke or heart attack through estrogen exposure would seem to be a risk but hopefully controlled through careful monitoring and dosing.
Love Linda