AskDocQ: HRT Is Safer Than We Previously Thought, Researchers Say


Hola amigos! I’m back from Buenos Aires, Argentina, where I attended the 25th meeting of the World Professional Association for Transgender Health (WPATH), an organization formed back in 1979.

WPATH is most famous for their Standards of Care, a set of guidelines for the medical management of trans and gender diverse people.

These guidelines have been the centre of much controversy over the years, not least because of their traditional gatekeeping approach, attacked by many trans activists and medical professionals as too proscriptive and based on outdated ideas regarding gender identity, and seen by many as “jumping through hoops” to get hormones and surgery.

The guidelines were last updated in 2012, and there were some big improvements, including the dropping of the mandatory requirement for psychiatric and psychological assessment prior to starting treatment, although they still suggested it was highly desirable.

The next rewrite is currently underway, and at the meeting we heard from all the different groups in charge of each separate chapter.

There are some well overdue changes coming, but many in the audience were concerned about how “US-centric” the guidelines will be, with most of the authors coming from the US and a few other first-world European nations.

Although they call themselves a world organization, there was very little representation from low resource countries, both within the chapter groups and the conference program.

HRT safer than previously thought

A big conference highlight for me was a session on hormonal management of non-binary people – clinicians are finally recognizing that non-binary people are not going away, and we need to acknowledge that their hormonal needs are different and more nuanced.

There is very little published research in this area and we need more.

There were several presentations on medical risks of HRT, and the consensus was that low bone density, breast cancer risk, and cardiovascular risk have all been overestimated.

It appears that, apart from the increased risk of blood clots with certain types of oestrogen, HRT is much safer than previously thought.

There were discussions about sexual health for trans people, an area that is often neglected, and some excellent talks on fertility and puberty blockers.

During the open mic session at the end of the conference prominent surgeon Marci Bowers stood up and called for a relaxation of the lower age limit for gender-affirming surgery (currently 18), with much applause from the room. I predict we will see a lot of movement in this space in the future.

You can read a more detailed description of conference proceedings on my blog here. Please hit me up with your questions the next time you see me or send them in to QNews Magazine.

Dr Fiona Bisshop specialises in LGBT health and is available by appointment at Holdsworth House Medical Brisbane. Call (07) 3894 0794 or visit the Holdsworth House website. Read more by Dr Bisshop on her website here or contact her on Twitter. Send your health question to [email protected] and Dr Bisshop will answer them anonymously in QNews Magazine