Chronic liver disease and hepatology care in transgender and gender diverse populations.

Abstract

Transgender and gender diverse (trans) people experience unique minority stressors related to their gender identity, along with additional psychosocial and systemic stressors that contribute to health disparities. Many risk factors for chronic liver diseases, such as viral hepatitis, alcohol use disorder, and metabolic dysfunction, disproportionately affect trans people. There have also been historical concerns about the hepatic effects of gender-affirming hormone therapy (GAHT) that are predominantly based on data extrapolated from cisgender populations or hormone formulations that are no longer recommended for use. This Review provides the latest data on the hepatic effects of GAHT and an overview of chronic liver disease in trans populations. From a hepatology perspective, current data indicate that modern GAHT is generally safe when used according to guidelines, although important knowledge gaps remain. This Review calls for individual, institutional, and systemic changes in both clinical and research domains to address knowledge gaps and ensure culturally appropriate, evidence-based, and affirming care for transgender and gender diverse communities.