Gender-affirming hormone therapy may affect MS disease activity
In study, 7 of 10 transgender adults showed new MS signs after therapy
Hormone therapies used in gender-affirming care for transgender people may affect disease activity in multiple sclerosis (MS), a small new study reports, although its researchers cautioned that more research is are needed to more comprehensively assess its impact in MS.
The study, “Gender-affirming interventions and prognosis in multiple sclerosis,” was published in Multiple Sclerosis Journal.
In recent years, there’s been a growing recognition of transgender and gender-diverse identities, both referring to people who don’t identify with the sex they were assigned at birth. Transgender women are women who were assigned male at birth, whereas transgender men are men who were assigned female at birth.
Gender-affirming care often involves hormone therapy — typically estrogen for transgender women and testosterone for transgender men — to help transgender people’s bodies better reflect their internal sense of self. For example, transgender women will grow breasts with hormone therapy and transgender men will grow facial hair.
In MS, the immune system launches an inflammatory attack that damages nerve cells in the brain and spinal cord. Hormones like estrogen and testosterone can affect the immune system in complex ways, so it’s plausible that hormone-based therapy used for gender-affirming care could affect MS disease activity. There’s virtually no data about how hormone therapies impact MS however, even though research suggests nearly 1 in 200 people with MS identify as transgender or gender-diverse.
“Both sex chromosomes and sex hormones impact the immune system. However, the effect of cross-sex hormone administration on MS is not sufficiently studied and potentially contributes to alterations in disease course in [transgender and gender diverse people with] MS,” the researchers wrote.
MS activity after gender-affirming care
Here, scientists report on outcomes from 10 transgender adults — five women and five men — who started hormone therapy. Soon after initiating gender-affirming care, seven of them (four women, three men) had new signs of disease activity visible on MRI scans. Of them, one woman and two men also had new clinical activity, that is, new or worsening MS symptoms.
“[I]n our cohort, most patients experienced increased disease activity after [gender-affirming hormone therapy] initiation, with a comparable [distribution between transgender men and transgender women],” the researchers wrote.
Disability was higher in transgender women than men, however, with researchers noting that the disease course in MS may differ between them.
Most of the adults had been diagnosed with MS before starting hormone therapy, but new MS activity following the start of hormone therapy marked the first onset of MS in two of the cases. “One [transgender woman] and one [transgender man] developed symptomatic MS within the first year of [gender-affirming hormone therapy],” the researchers wrote.
The data indicate that gender-affirming hormone therapy may increase MS activity, said the researchers said, who cautioned that the patient sample was too small to be able to draw a firm conclusion about cause-and-effect in their study. Only one patient was taking a disease-modifying therapy, which can reduce the risk of MS disease activity.
The researchers emphasized that more research is needed to study the impact of hormone therapy in transgender people with MS.
A commentary published with the study echoed this point, noting that a search on one of the main bibliographic databases for studies on transgender people with MS yields only about 10 papers, whereas a search for MS and progressive multifocal leukoencephalopathy (PML) yields hundreds, even though this rare type of brain infection that can affect people taking certain MS treatments affects fewer than 2% of MS patients..
“Researchers should address the gaps on gender diversity and gender-affirming hormonal treatments, in particular in relation to MS outcomes and potential interactions with MS management,” noted the commentary, which advised that “people involved in MS care should be genuinely inclusive, with sensitive and gender-neutral attitudes” in order to provide the best possible care for transgender and gender-diverse people with MS.
About the Author
