It’s common to encounter uninformed claims online about the supposed toxicity, carcinogenicity, or outsized health risks of medical treatment for trans people, such as puberty blockers and hormone therapy. While such claims are almost universally unsubstantiated, positive evidence for the safety of affirming medical care is of great value in putting these misconceptions to rest and lowering the perceived barriers for trans people who are considering accessing these treatments.
A recent study of trans youth by Olson-Kennedy et al. (2018) provides such evidence. 59 trans girls and trans boys between the ages of 12 and 24 presenting for treatment at Children’s Hospital Los Angeles received a followup assessment after 21 to 31 months of hormone therapy. While trans girls were found to have changes in certain metabolic parameters, these were “not clinically significant”, and their HDL cholesterol and hemoglobin remained within a normal cisgender female range. Most participants’ blood pressure and glucose levels were within a normal range as well.
Trans boys were overall found to experience “mildly” clinically significant changes in HDL cholesterol and blood pressure, and no changes in BMI, total cholesterol, or glucose levels. Increases in triglycerides, AST, ALT, hemoglobin, and potassium were not clinically significant. The authors conclude:
Frequent concerns about the safety of hormone use in individuals younger than 18 years can create barriers for youth to access medically necessary interventions that have been demonstrated to improve the lives of transgender adolescents. Concerns about the impact of cross-sex hormones on metabolic parameters are starting to be assuaged with clinical experience, retrospective analysis, and more recently, the undertaking of prospective, longitudinal investigations. Among this cohort of youth reported here, there were several statistically significant changes in mean values of physiologic parameters over time, but these did not translate to clinical safety concerns. Hormone levels were impacted as anticipated, and reflect the therapeutic goals of the care. These data indicate that gender-affirming hormone therapy is safe over a time period of approximately two years.
While further clinical studies will be needed to gather more evidence on the safety of hormone therapy for trans youth over the long term, the current study revealed no unexpected health risks or harmful impact on these youth from HRT. These findings reflect what is already known about transition care in trans adults: cross-sex hormone therapy is broadly a safe treatment for gender dysphoria. ■