February 13, 2019 / 9:48 PM / 6 months ago

Gender-affirming treatment tied to better quality of life for older adults

(Reuters Health) - Older transgender adults have a better quality of life when they get drugs or surgery to help their bodies match their gender identity, a U.S. study suggests.

Research on the psychological benefits of hormones and surgeries that align transgender people’s outward appearance with their gender identities has largely focused on younger people, researchers note in LGBT Health.

The current study compared outcomes for transgender adults treated before and after age 60, however, and found older patients reported greater gains in quality of life from gender-affirming treatments than younger people.

“Even though transgender individuals are recommended to medically transition at an early age, old age alone should not deter transgender individuals from seeking gender-affirming medical treatments,” said lead study author Xiang Cai of the Columbia University Mailman School of Public Health in New York City.

“Undergoing gender-affirmative medical treatments has shown to be associated with improved psychological wellbeing (e.g., higher life satisfaction and lessened gender dysphoria) among transgender adults, regardless of age,” Cai, who did the study at Yale University in New Haven, Connecticut, said by email.

The study included 1,442 transgender men and 978 transgender women. Most were white.

Compared to participants who didn’t have any gender-affirming treatment, adults under age 60 who did have treatment were more than twice as likely to report high quality of life scores in surveys. And, people over age 60 who had gender-affirming treatment were more than eight times as likely to report high quality of life scores afterward.

Overall, recent gender-affirming treatment was also associated with higher quality of life scores compared with not getting treatment.

The effect of gender-affirming treatment on quality of life appeared more pronounced for transgender women than for transgender men, the study found.

Older adults might experience greater improvements in quality of life after gender-affirming treatment because they’ve developed strategies for coping with stigma related to their age and gender identity, and these strategies might help them navigate the treatment process more successfully, the study authors suggest.

Older transgender people also may have been happier after gender-affirming treatment because they had lower expectations than younger people, the authors note.

The study wasn’t designed to prove if or how gender-affirming treatment impacts quality of life. It also didn’t distinguish between treatment options like hormone therapy and surgical procedures, or examine data on side effects of these interventions.

“Gender-affirming therapies are very personal decisions; individuals should consult with their physician and a specialist in gender-affirming therapies to determine their risk of adverse events (based on their medical history and chronic health problems) versus quality of life benefits,” said Dr. Marie Crandall, a surgery researcher at the University of Florida College of Medicine in Jacksonville who wasn’t involved in the study.

Risks of hormones are generally lower than risks of surgery, doctors say.

With hormone therapy, transgender women have a lower risk of prostate cancer than men who aren’t transgender, and a higher risk of certain other tumors including thyroid malignancies, for example.

Transgender women who take estrogen may also have a higher risk of blood clots and strokes than men and women who aren’t transgender.

“In terms of surgical gender-affirming therapies, older people are more likely to have chronic health problems and, therefore, more likely to have complications related to surgery such as infections, heart attacks or strokes, to name a few,” Crandall said by email.

The benefits of surgery and hormones are both physical and psychological, said Dr. Stuart Chipkin, a public health researcher at the University of Massachusetts Amherst who wasn’t involved in the study.

“Hormone and surgical therapies can help someone look more like how they see themselves and how they want the world to see them,” Chipkin said by email. “These treatments also help people to have a less disconnected feeling between their brains and their bodies.”

SOURCE: bit.ly/2X9PDfY LGBT Health, online January 16, 2019.

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