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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Evidence suggests inflammatory bowel disease is equally prevalent in transgender and cisgender populations. However, it remains unclear whether gender-affirming care and the higher rates of trauma experienced by many transgender patients affect disease course. As political pressure threatens access to gender-affirming hormone therapy (GAHT), patients with IBD who are transgender are increasingly caught in an uncertain care landscape. Major knowledge gaps remain around how hormone therapy may affect Crohn\u2019s disease and ulcerative colitis, as well as the psychosocial challenges of being transgender and navigating gastrointestinal care.
Image: Rainbows in Gastro. Reprinted with permission.
\u201cThere is an urgent need to close many gaps in literature,\u201d Victor Chedid, MD, MS, gastroenterologist and director of the IBD Pride Clinic at Mayo Clinic, told Healio. \u201cMore data and guidelines will help us better care for patients from the LGBTQ+ community, including transgender and gender-diverse populations who are living with inflammatory bowel disease.\u201d Among other important steps toward building trust with patients, having an inclusive and respectful space is critical to caring for patients who are transgender and have IBD, according to Kira Newman, MD, PhD, clinical assistant professor of internal medicine at Michigan Medicine. Newman emphasized that individuals with IBD often spend a significant amount of time interacting with the health care system. Kira Newman For patients who are transgender, that \u201cpresents a lot of opportunities to come in contact with individuals who may have stigma against trans people or systems where they feel like they\u2019re not seen or heard,\u201d Newman, whose clinical research focuses on health care equity for LGBTQ+ people with digestive diseases, said. Chedid has conducted studies with focus groups of patients in the LGBTQ+ community and found that many of them have experienced aggressive or dismissive care, which has eroded their trust in clinicians. \u201cPatients living with IBD need prompt care,\u201d he said. \u201cIf somebody has a history of [experiencing] discrimination and stigma and a mistrust of health care, they might delay and only present to clinic when their disease is more severe.\u201d IBD care and flares Newman and Chedid were investigators in a key retrospective, multicenter study published in Clinical Gastroenterology and Hepatology in 2023 that evaluated IBD flares among patients in the transgender community. \u201cWe found there was no overall increase in IBD flares in the year after starting gender-affirming hormone therapy, which was a reassuring finding for providers and patients,\u201d Chedid said. Victor Chedid He did note that patients with active IBD or inflammation when GAHT was initiated were more likely to experience a flare the following year. \u201cThat speaks to the importance of including an IBD provider in the gender-affirming care of a patient, because at the time of initiation of gender-affirming care \u2014 especially gender-affirming hormones \u2014 it will be important to get the IBD in deep remission to reduce the risk of flaring,\u201d Chedid said. Chedid also recommends that clinicians be proactive and \u201cconsider noninvasive monitoring within the first 3 months of initiating hormones with stool-based testing, such as fecal calprotectin, and again at 6 months and 1 year.\u201d Newman concurs that clinicians should continue observing patients during this period. \u201cIt appears that GAHT is safe and does not cause flares, but it is important to monitor anyone going through a major physiologic change, just like we would monitor people as they go through pregnancy or treatment for a major comorbid illness,\u201d she said. Newman also highlighted the importance of recognizing that GAHT is not one monolithic treatment and not every patient is taking the same formulation. \u201cIf there is a liver-related injury we think is related to medication, [we should] assess all of a patient\u2019s medications, including their GAHT,\u201d Newman said. She added that clinicians should be aware that GAHT also differs in dosage and duration of action. If patients experience complications, it may be important to confirm they are obtaining GAHT from a licensed practitioner. Newman recommends asking where patients obtain their medications because, \u201cwhile many transgender people are fortunate to be able to access clinics where they can get gender-affirming care, not everyone who is on GAHT is accessing that through a clinic.\u201d Another point of concern is how feminizing hormone therapy specifically may interact with IBD. \u201cEstradiol, especially if given orally, can increase the risk of venous thromboembolism, which is also a concern in patients with severe IBD,\u201d Laura Targownik, MD, told Healio. Targownik is a clinician researcher at Mount Sinai Hospital in Toronto and president of Rainbows in Gastro, an organization that advocates for the LGBTQ+ community in gastroenterology and hepatology spaces. Laura Targownik She said there are still questions about how those two risk factors for venous thromboembolism interact, particularly when a third risk factor is added, like hospitalization. In those specific cases, Targownik said she believes temporarily pausing therapy could be a consideration to lower the risk for DVT. But in general, she emphasized that gastroenterologists should not think of GAHT as any less important than any other medication they may be on for any concomitant condition. \u201cEven though we recognize some medications prescribed for other conditions can theoretically cause GI symptoms or impact a patient\u2019s IBD, we\u2019re pretty circumspect about telling people to stop medications that other [clinicians] have prescribed,\u201d Targownik said. Alexander Michael Goldowsky, MD, attending gastroenterologist at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School, cautions clinicians about \u201ctransgender broken arm syndrome,\u201d a phenomenon where any condition a transgender individual is experiencing, up to and including a broken arm, is blamed on their GAHT. Goldowsky advises clinicians to avoid making assumptions and automatically attributing concerns a patient who is transgender<\/p>\n","protected":false},"author":1,"featured_media":2796,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2795","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/2795","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2795"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/2795\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/2796"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2795"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2795"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2795"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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