Study Calls for Nuanced Approach to Stroke Care in Sexual and Gender Diverse Patients
Sexual and Gender Diverse Patients May Have Unique Stroke Risk Factors Related to Minority Stress, Social Disparities, and Effects of Gender-Affirming Hormone Therapy
Health disparities and unique stressors may shape stroke risk and other cerebrovascular conditions among sexual and gender diverse (SGD) individuals—those who identify as transgender, nonbinary, or intersex—according to a review study conducted by New York Medical College faculty and students and published in Neurology Clinical Practice.
“Stroke risk in SGD patients may be influenced by a combination of minority stress, health care disparities, and effects of gender-affirming hormone therapy (GAHT) use,” explains Alice Catalano, SOM Class of 2027, one of the co-authors on the study. “During this research, I discovered that transgender patients often encounter health care providers who were quick to attribute their health conditions to gender-affirming treatments—any medical steps taken as part of a gender transition, including hormone therapy and surgeries—overlooking other potential causes. While gender-affirming treatments can carry some risks, as is true with any treatment, what those risks actually entail is not well studied.”
GAHT often involves testosterone replacement therapy for transmasculine patients, or estrogen with or without an anti-androgen, such as spironolactone, for transfeminine patients. “While there is some evidence that gender-affirming estrogen therapy elevates stroke risk, we recommend caution in discontinuing estrogen therapy following a stroke because it also has significant positive effects on mental health and health-related behaviors, such as exercise,” says Catalano.
While current evidence does not show an increased risk of stroke in transmasculine patients receiving gender-affirming testosterone therapy, data remains limited. “Both testosterone and estrogen hormone therapy may interact with some medications typically used for stroke prevention,” says Catalano. “Therefore, decisions surrounding the discontinuation of hormone therapy in SGD patients following a stroke should be made collaboratively with the patient, neurologist, and gender-affirming hormone prescriber.”
“Our study contributes to a deeper understanding of the complex interplay between GAHT and stroke risk, so that both providers and patients can make well-informed healthcare decisions” concludes Catalano. “Our findings highlight the need for healthcare environments that are inclusive and affirming of SGD patients, who have demonstrated high rates of healthcare avoidance due to prior mistreatment in the healthcare system. Finding ways to create positive environments for people of all different backgrounds could make a significant impact on the happiness and well-being of everyone.”
