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Review
Considerations for the care of transgender patients in orthopaedics and sports medicine: a narrative review
  1. Madison Hayes-Lattin1,
  2. Laura M Krivicich2,
  3. Jack T Bragg2,
  4. Ashley Rogerson3,
  5. Matthew J Salzler2
  1. 1 Tufts University School of Medicine, Boston, Massachusetts, USA
  2. 2 Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, USA
  3. 3 Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
  1. Correspondence to Dr Matthew J Salzler; MSalzler{at}tuftsmedicalcenter.org

Abstract

Orthopaedic and sports medicine clinicians can improve outcomes for transgender patients by understanding the physiological effects of gender-affirming hormone therapy (GAHT). This narrative review investigated the role of GAHT on bone mineral density, fracture risk, thromboembolic risk, cardiovascular health and ligament/tendon injury in this population. A search from the PubMed database using relevant terms was performed. Studies were included if they were levels 1–3 evidence. Due to the paucity of studies on ligament and tendon injury risk in transgender patients, levels 1–3 evidence on the effects of sex hormones in cisgender patients as well as basic science studies were included for these two topics. This review found that transgender patients on GAHT have an elevated fracture risk, but GAHT has beneficial effects on bone mineral density in transgender women. Transgender women on GAHT also have an increased risk of venous thromboembolism, stroke and myocardial infarction compared with cisgender women. Despite these elevated risks, studies have found it is safe to continue GAHT perioperatively for both transgender women and men undergoing low-risk operations. Orthopaedic and sports medicine clinicians should understand these unique health considerations for equitable patient care.

  • Athletic Injuries
  • Bone density
  • Orthopedics
  • Review
  • Sports medicine

https://doi.org/10.1136/bjsports-2023-107703

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    Footnotes

    • X @LattinHayes

    • Contributors All authors have made substantial contributions to the drafting and revision of this review. MJS is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.