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.

中文翻译：

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骨科和运动医学中跨性别患者护理的考虑因素：叙述性回顾


骨科和运动医学临床医生可以通过了解性别肯定激素疗法 (GAHT) 的生理效应来改善跨性别患者的治疗效果。这篇叙述性综述调查了 GAHT 对这一人群的骨矿物质密度、骨折风险、血栓栓塞风险、心血管健康和韧带/肌腱损伤的作用。使用相关术语从 PubMed 数据库中进行搜索。如果研究属于 1-3 级证据，则纳入研究。由于关于跨性别患者韧带和肌腱损伤风险的研究很少，因此这两个主题纳入了关于性激素对顺性别患者影响的 1-3 级证据以及基础科学研究。本综述发现，接受 GAHT 治疗的跨性别患者骨折风险较高，但 GAHT 对跨性别女性的骨矿物质密度具有有益作用。与顺性别女性相比，接受 GAHT 治疗的跨性别女性发生静脉血栓栓塞、中风和心肌梗死的风险也增加。尽管风险较高，但研究发现，对于接受低风险手术的变性女性和男性来说，围手术期继续 GAHT 是安全的。骨科和运动医学临床医生应该了解这些独特的健康考虑因素，以实现公平的患者护理。