{"id":1576,"date":"2024-03-31T23:05:31","date_gmt":"2024-03-31T23:05:31","guid":{"rendered":"https:\/\/juventudeemtransicao.pt\/?p=1576"},"modified":"2024-03-31T23:15:19","modified_gmt":"2024-03-31T23:15:19","slug":"we-actually-dont-know-much-the-scientists-trying-to-close-the-knowledge-gap-in-trans-healthcare","status":"publish","type":"post","link":"https:\/\/juventudeemtransicao.pt\/index.php\/2024\/03\/31\/we-actually-dont-know-much-the-scientists-trying-to-close-the-knowledge-gap-in-trans-healthcare\/","title":{"rendered":"We actually don\u2019t know much\u2019: the scientists trying to close the knowledge gap in trans healthcare."},"content":{"rendered":"\t\t
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Artigo original publicado no The Guardian<\/span><\/h5>\n

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Researchers are running trials on how hormone therapies affect trans people that will also benefit healthcare for the wider population<\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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When Cameron Whitley was diagnosed with kidney failure seven years ago, the news came as a shock. But the situation was about to get worse. His doctor decided the diagnosis meant Whitley\u2019s hormone therapy had to stop.<\/p>\n

As a transgender man, now 42, who had taken testosterone for 10 years, the impact was brutal.<\/p>\n

\u201cNot only was I struggling with this new diagnosis that I\u2019m in stage four kidney failure, now I\u2019m being told that I can no longer have hormones,\u201d said Whitley, an associate professor in the department of sociology at Western Washington University. \u201cI cannot describe how horrible that moment was.\u201d<\/p>\n

Crucially, he says, the decision was completely unnecessary. \u201cWe call this within the medical community \u2018trans broken arm syndrome<\/a>\u2019,\u201d he said.<\/p>\n

The term refers to medical situations \u2013 such as having a broken arm \u2013 that are unconnected to gender identity, yet healthcare providers act on the basis there is a connection.<\/p>\n

\u201cWe didn\u2019t have any established sense that being on hormones would be problematic. The hormones are not processed through the kidneys. So there was nothing that made it [necessary to stop them], but that was the first thing that was done,\u201d he said.<\/p>\n

Whitely has since transferred his care over to the University of Pennsylvania, which he described as \u201cawesome [with] wonderful trans-competent care\u201d.<\/p>\n

An increase in the number of people coming out as transgender has led to growing use of hormone therapies, which help to\u00a0change the body\u2019s physical characteristics<\/a>\u00a0towards a certain gender.<\/p>\n

But as Whitley found out, misunderstandings and knowledge gaps about their impact abound.<\/p>\n

While hormone therapies are today best known for their use in contraception or to manage symptoms of menopause in cisgender women, they have for decades been given to people undergoing gender reassignment. The German doctor\u00a0Magnus Hirschfeld was one of the first to offer such medications to his patients<\/a>\u00a0at his\u00a0Institute for Sexual Research<\/a> in Berlin, which he opened in 1919.<\/p>\n

Many people who are trans say such \u201ccross-sex\u201d or \u201cgender affirming\u201d hormone therapies are crucial: allowing them to live in a way that makes them happy and\u00a0significantly reducing the risk of depression<\/a>\u00a0and suicide.<\/p>\n

However, their use in younger people with gender dysphoria is controversial, not least because of their potential impact on fertility and the irreversible changes they can produce.<\/p>\n

Until recently, gender-affirming hormone therapies in England could be given on the NHS after the age of 16, and individuals must have been on\u00a0drugs known as puberty blockers<\/a>\u00a0for at least a year.<\/p>\n

Puberty blockers pause the physical changes associated with adolescence, but have themselves been a key focus of concern when it comes to the medical treatment of children with gender dysphoria due to questions about their safety and clinical effectiveness.<\/p>\n

New rules released by NHS England this month<\/a>\u00a0mean puberty blockers will no longer be used in treatments for under-18s with gender dysphoria, except as part of a clinical trial. A spokesperson for NHS England said amendments to the cross-sex hormones policy are being finalised in light of the new rules.<\/p>\n

But away from the public debate about who should have hormone therapies and when, growing numbers of researchers are beginning to delve into their impact on the body in a bid to improve healthcare for trans people \u2013 and for the wider population.<\/p>\n

For trans men, hormone therapy typically involves taking testosterone<\/a>\u00a0\u2013 enabling the growth of facial hair and a deepening of the voice, amid other changes \u2013 while for\u00a0trans women it typically means taking<\/a>\u00a0oestradiol, which promotes the growth of breasts and an increase in body fat.<\/p>\n

While such medications are known to change external appearances, how they might affect other aspects of the body \u2013 from the way internal organs work, to blood pressure and even risk factors for diseases \u2013 has been unclear. And that isn\u2019t just true for trans patients.<\/p>\n

\u201cRegardless of the type of [hormone] therapy and who is using it, we actually surprisingly as a healthcare profession don\u2019t know much,\u201d said Dr Sofia Ahmed of the University of Alberta, who is looking at the impact of hormone therapy on kidney and cardiovascular health in transgender people.<\/p>\n

\u201cIn using hormonal contraception, for example, we know it prevents pregnancy, but we have a limited understanding of how it affects kidney function, blood pressure, cardiovascular health \u2013 and that holds true for truly any kind of hormone therapy.\u201d<\/p>\n

For trans people taking hormone therapies, medics have raised particular concerns over standard \u201chealthy\u201d ranges for metrics such as blood pressure, kidney filtration rates or liver function.<\/p>\n

These ranges are known to differ between cisgender men and women, but it is\u00a0unclear what a \u201chealthy\u201d range is for trans men and women taking hormones<\/a>\u00a0\u2013 a situation doctors have said could put trans patients at risk of receiving the wrong dose of a medication, diseases being missed or even conditions being erroneously diagnosed.<\/p>\n

Among those attempting to resolve the issue is Devon Buchanan, a clinical scientist with Synnovis who is running a trial based at King\u2019s College hospital that began in April 2021 and is recruiting 240 trans and non-binary people.<\/p>\n

\u201cWe know that those \u2018normal\u2019 ranges are affected by gender affirming hormone therapy which a lot of trans people take and is very important to them,\u201d she said.<\/p>\n

Many previous studies have been small and the results unclear. \u201cWe wanted to cover a wide variety of tests and also have a larger sample size so that we could be more sure about the results,\u201d said Buchanan.<\/p>\n

Studies have also suggested\u00a0rates of obesity in trans people are higher<\/a>\u00a0than among those who are cisgender, but the reason for such disparities is unclear. Dr Sascha Heinitz of the University of Leipzig is examining the\u00a0effects of hormone therapy on eating behaviour, metabolism, energy balance and the cardiovascular system<\/a>\u00a0in transgender people.<\/p>\n

He and colleagues are following 20 trans men and 20 trans women, and the same number of cisgender participants, over a two- to five-year period.<\/p>\n

\u201cWe [are] just trying to understand [whether], during gender affirming hormone therapy, [are] there any changes going on that increase the risk of developing these diseases,\u201d he said.<\/p>\n

Even if evidence points to a\u00a0greater metabolic risk in individuals receiving hormone therapy<\/a>, as some research has suggested, further work will be needed to explore the extent to which that could be down to physiological response of the body to therapy, changes to experiences of gender dysphoria, or behavioural changes around consumption of food, Heinitz noted.<\/p>\n

Also in Germany, Dr Sofia Forslund-Startceva of the Max Delbruck Center in Berlin and colleagues are running a clinical trial with 200 transgender people to explore whether\u00a0risk factors for cardiovascular disease relating to changes in the makeup of the gut microbiome<\/a>\u00a0that are known in cis men and women emerge as trans men and women take hormone therapy.<\/p>\n

\u201cIn so doing, we can both learn more about the mechanisms underlying health disparities between cis men and cis women, and learn more on when and where and after how long in transition a trans person [is] better treated as someone of their reassigned sex as of their birth assigned sex,\u201d she said.<\/p>\n

Such research could also help to achieve personalised medicine by offering insights into the relationship between health and changing levels of various hormones.<\/p>\n

For example, risk factors for various diseases are known to increase among post menopausal cisgender women, who have lower oestrogen levels and higher levels of hormones known as FSH and LH compared with those who are younger.<\/p>\n

\u201cWhere I would like to see this going, both in cisgender medicine, in intersex care and in trans care, is perhaps to recognise the importance of sex and gender in medicine and healthcare,\u201d she said, adding \u201cmaleness\u201d and \u201cfemaleness\u201d can exist in individuals to different degrees.<\/p>\n

In other words, given levels of sex hormones can undergo a profound shift across an individual\u2019s lifespan, whether cisgender or transgender, understanding their impact could have important implications for everyone\u2019s healthcare.<\/p>\n

Work in transgender health is still a relatively new field, and funding can be a struggle, as can recruiting a meaningful number of participants who are representative of the community.<\/p>\n

And research does not occur in a vacuum: around the world transgender issues are a hot political and social topic, whether it\u2019s the age at which individuals can access hormone therapy or who can use single-sex spaces.<\/p>\n

\u201cIt is my experience, also from my outpatient clinic, that there is not only lack of knowledge, but also lack of interest, and also people who do not want to treat transgender individuals,\u201d said Heinitz. \u201cI think some people just don\u2019t want to touch the topic because it\u2019s too hot.\u201d<\/p>\n

Forslund-Startceva said her impression was not that the topic was avoided out of any fear of controversy. \u201cThat said, there may be a reluctance at least on the part of some [who see themselves as trans allies] to approach it since they fear as outsiders to the demographic that they would not be able to research accountably,\u201d she said.<\/p>\n

Some advocate the \u201cnothing about us without us\u201d approach, stressing teams without transgender members risk misunderstanding the community they are seeking to work with, could end up failing to ask the best questions to inform their research, and might run into problems when it comes to communicating results in a nuanced and comprehensive way.<\/p>\n

\u201c[The latter] matters when research becomes weaponised so quickly, because people will latch on to potential interpretations and misinterpretations and use them one way or the other as culture war tools that can do a lot of damage,\u201d said Forslund-Startceva.<\/p>\n

But the value of lived experience among researchers is contested. \u201cYou cannot bring anything personal into [the research] except for inter-individual contact, being friendly and nice,\u201d said Heinitz.<\/p>\n

\u201cTo have transgender individuals in this field is great. Not to have them would be not so good. But I mean, it\u2019s not important to have subjects with kidney disease conducting a study on kidney disease.\u201d<\/p>\n

Despite the challenges, scientists say the possibilities of the new wave of research into hormone therapies is exciting, offering the chance to fundamentally change healthcare for the transgender community and more widely. \u201cIt has multiple layers,\u201d said Heinitz. \u201cIt\u2019s a beautiful field, I think.\u201d<\/p>\n

Forslund-Startceva agreed. \u201cWe start in the understanding that health and disease risks and responses differ between cis men and cis women, but one cannot easily entangle different components of sex or gender \u2013 is it due to lifestyle, hormones or genetics?\u201d<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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IR PARA ARTIGO ORIGINAL<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Artigo original publicado no The Guardian Por Nicolas Davis Researchers are running trials on how hormone therapies affect trans people that will also benefit healthcare for the wider population When Cameron Whitley was diagnosed with kidney failure seven years ago, the news came as a shock. But the situation was about to get worse. His […]<\/p>\n","protected":false},"author":1,"featured_media":1577,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"elementor_theme","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[10],"tags":[],"class_list":["post-1576","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-internacional"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/posts\/1576","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/comments?post=1576"}],"version-history":[{"count":4,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/posts\/1576\/revisions"}],"predecessor-version":[{"id":1581,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/posts\/1576\/revisions\/1581"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/media\/1577"}],"wp:attachment":[{"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/media?parent=1576"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/categories?post=1576"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/tags?post=1576"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}