Magazine Seminars in Arthritis and Rheumatism has published for the first time an article in which a review of rheumatic diseases in transgender people.
It is a milestone, since in Medicine, diseases “are studied through the male/female binary gender and, when evaluating a clinical case, in most consultations, there is a tendency to presume said heterosexuality ”, according to the Spanish Society of Rheumatology (TO BE).
Lack of studies on ‘trans’ people
In the article, a group of Spanish rheumatologists carry out a review following a search methodology for bibliographic sources, with a scoping review or scope review. It reveals the lack of scientific studies on immune-mediated inflammatory rheumatic diseases, such as lupus or scleroderma, in transgender people.
“Except for the field of osteoporosis, the published information that we have found on other rheumatic pathologies is anecdotal, so that there is a very significant lack in the available medical literature on immune-mediated diseases in ‘trans’ people“explains the doctor Eva Salgado, first author of said review and rheumatologist at the Complexo Universitario Hospitalario de Ourense.
“For example, it does not include whether having received hormonal treatments, or having undergone some surgical techniques, such as silicone implants, might have any impact on the autoimmune processes of the disease,” he adds.
Likewise, the specialist affirms that despite the fact that the number of cases of ‘trans’ patients found in the scientific bibliography is small, most of these occur in transgender women. For this reason, he recalls that, precisely, “the absence of solid data justifies caution when establishing recommendations regarding hormone replacement therapy in transgender people who have this type of pathology.”
A change in medicine
Dr. Salgado insists on the need to investigate and apply a change in Medicine, so that diseases are not only studied under the prism of binary gender.
The specialist in Rheumatology has also wanted to reassure transgender people who might suffer from a rheumatic disease, since she assures that, “in principle, in ‘trans’ people there would not be a delay in the diagnosis of rheumatic diseases with respect to the rest of the population, since the ‘cis’ or ‘trans’ condition would not influence the diagnosis”.
Of course, Salgado emphasizes the need to study the influence that some hormonal treatments might have in autoimmune diseases in order, in this way, to be able to offer the best care to patients.
Study of the transgender patient in Rheumatology
In 2018, the SER, under the presidency of Dr. Juan Gomez-Kingdom, launched a Transgender Advisory Committee with the aim of trying to answer the questions that may arise in the consultation when a ‘trans’ person suffers from a rheumatic disease. And it is that the process to change your body and adapt it to your gender identity entails a series of treatments -including hormone therapy and some surgeries- that might induce certain pathologies.
For example, SER highlights, it has been shown that in the transition from man to woman there is a significantly higher risk of venous thromboembolism and stroke.
“If the risks of treatment are known, preventive programs can be applied and hacer active surveillance of possible comorbidities, so that comprehensive health care for ‘trans’ people can be carried out as Transgender Medicine, that is, a multidisciplinary care of all the bio-psycho-social aspects of this group of people, always from a depathologizing perspective and with the aim of improving their quality of life”, concludes Salgado.
