Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults

Sep 28, 2026

Uploaded by Noah

As transgender and gender diverse (TGD) people age, more transfeminine and transmasculine individuals seek to initiate or continue gender-affirming care at older ages. Existing guidelines provide strong support for gender-affirming hormone therapy, primary care, surgery, and mental health, yet often lack age-specific tailoring for older adults. Evidence informing guideline management largely comes from younger TGD cohorts, leaving uncertainty about extrapolation. This perspective review addresses cardiovascular risk, hormone-sensitive cancers, bone and cognitive health, gender-affirming surgery, and mental health considerations in older TGD patients on GAHT.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

Introduction

Gender-affirming care components and evidence gaps in older TGD adults

Sources of data (European cohorts and US cohorts)

Need for age-tailored guidance and future study directions

Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults Sean J. Iwamoto, Justine Defreyne, Christodoulos Kaoutzanis, Robert D. Davies, Kerrie L. Moreau and Micol S. Rothman Abstract: As the transgender and gender diverse (TGD) population ages, more transfeminine and transmasculine individuals present to clinic to initiate or continue their gender-affirming care at older ages. Currently available guidelines on gender-affirming care are excellent resources for the provision of gender-affirming hormone therapy (GAHT), primary care, surgery, and mental health care but are limited in their scope as to whether recommendations require tailoring to older TGD adults. Data that inform guideline-recommended management considerations, while informative and increasingly evidence-based, mainly come from studies of younger TGD populations. Whether results from these studies, and therefore recommendations, can or should be extrapolated to aging TGD adults remains to be determined. In this perspective review, we acknowledge the lack of data in older TGD adults and discuss considerations for evaluating cardiovascular disease, hormone-sensitive cancers, bone health and cognitive health, gender-affirming surgery, and mental health in the older TGD population on GAHT. Keywords: aging, bone health, cancer, cardiovascular disease, cognitive health, gender diverse, gender-affirming hormone therapy, gender-affirming surgery, mental health, transgender Received: 17 July 2022; revised manuscript accepted: 13 March 2023. Introduction Gender-affirming care may include genderaffirming hormone therapy (GAHT), genderaffirming surgery, and gender-affirming mental health care, depending on the individual goals of each transgender and gender diverse (TGD) person. Most data informing our knowledge about TGD medical, mental health, and surgical outcomes come from large European cohorts with a small proportion of older adults. The Amsterdam Gender Clinic, which has provided genderaffirming care since 1972, reportedly had 700 of 4432 (16%) transfeminine (i.e. person with male sex recorded at birth who has a female/feminine gender identity) and 250 of 2361 (11%) transmasculine (i.e. person with female sex recorded at birth who has a male/masculine gender identity) adults reach the age of 60 years or above in 2015.1 The European Network for the Investigation of Gender Incongruence (ENIGI) has published many cross-sectional and prospective results on a variety of topics related to gender-affirming care. In 2016, Dekker et al.2 described the ENIGI Endocrine protocol, which has included TGD persons since 2010, as monitoring cohorts with relatively young median ages but a wide range of ages among transfeminine (n = 333, median age = 30 years, range = 16–65) and transmasculine (n = 343, median age = 24 years, range = 16–51) adults. By 2022, ENIGI had 1261 transfeminine and 1411 transmasculine patients in its cohort, as reported by Cocchetti et al.,3 with a growing proportion of older TGD adults being followed. Data from ENIGI are currently representative of a younger TGD population but hold promise for future studies assessing older TGD adults and age-related differences in health outcomes impacted by gender-affirming care. TherAdv Endocrinol Metab 2023, Vol. 14: 1–20 DOI: 10. 1177/ 20420188231166494 © The Author(s), 2023. Article reuse guidelines: [sagepub.com/journals](sagepub.com/journals)permissions Correspondence to: Sean J. Iwamoto Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Avenue, Aurora, CO 80045, USA. Endocrinology Service, Medicine Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA UCHealth Integrated Transgender Program – Anschutz Medical Campus, Aurora, CO, USA sean.iwamoto@ [cuanschutz.edu](cuanschutz.edu) Justine Defreyne Department of Endocrin

FAQs

Why do current gender-affirming care guidelines need tailoring for older TGD adults?

Guidelines support GAHT, primary care, surgery, and mental health, but their recommendations are limited in whether they require adaptation for older TGD adults. Much of the evidence derives from younger TGD populations.

What types of health areas does the review discuss for older TGD adults on GAHT?

The review focuses on evaluating cardiovascular disease, hormone-sensitive cancers, bone health, cognitive health, gender-affirming surgery considerations, and mental health in the older TGD population on GAHT.

What evidence gap exists regarding aging in TGD populations?

Data informing guideline management often comes from studies of younger TGD people, and it remains to be determined whether results from younger groups can or should be extrapolated to aging TGD adults.

Sep 28, 2026

Uploaded by Noah