Gender Affirming Care and IBD

Gender Affirming Care is a spectrum and all depends on your journey as a transgender and/or gender non-binary individual - from surgical affirmation to hormonal therapy to social transition, don’t let IBD prevent you from becoming your best self. Honestly, everyone engages in gender affirming care, from getting your nails done to your eyebrows waxed or hair replacement therapy - but making sure we do it in a way that’s best for us is the goal.

Gender Affirming Hormone Therapy (GAHT) and IBD

Busting myths about HRT and IBD, what to expect when starting HRT with IBD, and navigating ‘Transgender Broken Arm Syndrome’

GAHRT (Gender Affirming Hormone Replacement Therapy) is used by  some transgender individuals who wish to transition medically. This includes, but is not limited to, Testosterone ( Testosterone Cypionate or Proprionate SubQ Injection, Intramuscular Injection, Nebido Pellet, Testogel, and Patches) Estrogen, Estradiol, Progesterone, GnRH antagonists/puberty blockers, spironolactone, and more.

Transgender Broken Arm Syndrome is the phenomenon of healthcare providers misattributing symptoms of disease to your HRT or gender identity - in this case, that may look like a flare being blamed/attributed to your HRT.

There is limited research on transgender IBD patient health, however, testosterone replacement therapy has been shown to decrease CRP and pro-inflammatory cytokines

There is no evidence to show that either testosterone or estrogen in GAHT are harmful or damaging to the liver (trust me - I asked a real-deal hepatologist (liver doctor) on this one and confirmed it, your livers are good!)

In transgender men without IBD, gender-affirming hormone therapy led to a decrease in CRP and blood pressure

Recent research has shown there no overall risk for IBD flare in the year after gender-affirming hormone initiation.

A 2024 study at Johns Hopkins showed that GAHT was not associated with increased incidence of flares

We also have to consider the factors that make a flare and decrease CRP - if going on HRT makes you happier, less stressed and less dysphoric/happier in your body, you are probably going to be overall less likely to be all super stressed and worried, which we know contributes to flares. So it may be a causal thing - being happier in your body, being your true self, makes your body feel more comfortable and less flare-y than before when you are dysphoric and depressed and anxious.

It is important to talk to your healthcare team about what matters most to you. Stress and anxiety associated with gender dysphoria can contribute to overall distress that compounds flares, so these are multifaceted decisions.

Talk to your GI doctor and endocrinologist (or prescribing provider of HRT) about your specific situation - not all IBD experiences are the same as not all TGNC experiences are the same.