This review examines the effects of gender-affirming hormone therapy (GAHT) on kidney health in transgender and gender diverse (TGD) populations, which face significant challenges in accessing medical care. GAHT, typically involves estrogen therapy for transgender women and transfeminine individuals, testosterone therapy for transgender men and transmasculine individuals, and therapy regimens for individuals who are nonbinary or identify with another gender not culturally assigned to their sex assigned at birth. Hormone therapy influences biomarkers such as creatinine and cystatin C, which are used in estimating glomerular filtration rate (eGFR). Current eGFR equations, reliant on sex-specific factors, may misrepresent kidney function in TGD individuals, leading to misdiagnosis or misclassification of kidney disease stages. GAHT alters serum creatinine (SCr) and cystatin C differently in individuals who use masculinizing or feminizing hormones. Testosterone therapy often raises SCr, while estrogen therapy may lower or have no effect on SCr levels. Additionally, GAHT can impact chronic kidney disease (CKD) progression and the incidence of acute kidney injury (AKI) due to a myriad of factors including hormonal effects. Estrogen may offer renal protection, while testosterone may elevate risks. Clearly, more data is needed, especially concerning the long-term effects of GAHT on CKD and AKI incidence and progression among TGD individuals. Kidney transplant considerations for TGD patients are complex, involving factors such as the impact of hormone therapy on allograft and patient survivals, drug-drug interactions, as well as unique anatomical challenges The lack of inclusive data in kidney disease registries and national databases for TGD populations limits the understanding of the effect of GAHT on kidney health. This narrative review calls for comprehensive and longitudinal research to better define eGFR estimation in TGD individuals using GAHT and the broader implications of GAHT on kidney health outcomes.
Reema et al. (Fri,) studied this question.