Gender-affirming hormone therapy and impacts on quality of life: a narrative review

Background

Transgender and gender-nonconforming (TGNC) people often face significant disparities in health education and access to quality medical management. This narrative literature review examines the relationship between TGNC patients seeking hormone replacement therapy and resulting improved health outcomes.

Methods

Our search identified papers through the databases PubMed, PsycINFO, CINAHL, Embase, and Web of Science including search terms relating to gender-affirming hormone therapy (GAHT), transgender identities, and patient healthcare experiences and outcomes. Further inclusion criteria required papers published after 1979 with a majority of participants located in the United States. Data extraction and quality assessment of the selected papers were completed using the JBI Manual for Evidence Synthesis, a quality assessment tool created based on the Mixed Methods Appraisal Tool, and Covidence software. Common themes were narratively reviewed.

Results

The search yielded 19,482 results across five databases and 51 papers were included in data extraction and quality assessment. Most papers were published between 2020-2024 and enrolled young adults in cross-sectional studies. Recurrent themes observed from data synthesis include improved mental health and quality of life outcomes associated with GAHT use. Distance to clinics, cost of care, insurance coverage, and governmental policies were commonly identified barriers to obtaining gender-affirming care.

Conclusions

The identified gaps in information reflect the importance of additional research in TGNC health-related disparities including diverse participant populations and rigorous longitudinal methods. With these changes, we expect improved quality of care, patient satisfaction, and health outcomes for these individuals.

HIGHLIGHTS

• Gender-affirming hormone therapy is associated with reduced levels of depression, anxiety, and suicidal ideation in transgender and gender-nonconforming individuals

• Significant barriers to obtaining GAHT include high costs, lack of insurance coverage, limited access to knowledgeable healthcare providers, geographical distance to clinics, and discriminatory policies

• The number of studies on gender-affirming hormone therapy has increased significantly in recent years, reflecting growing recognition of the importance of transgender healthcare

• Most existing studies on GAHT and its effects are cross-sectional, limiting the ability to assess long-term outcomes

• Establishing standardized assessments for mental health outcomes, quality of life, and long-term effects of gender-affirming hormone therapy would enhance the reliability and comparability of future research