Análisis de contenido

This study has several limitations worth noting. First, the data were self-reported, including information on the year in which respondents firststarted taking each hormone, the total amount of time (in years) they had been on each hormone, and the years in which participants had had surgery and been diagnosed with the health outcomes of interest. These measures could not be validated, and may therefore be subject to recall

bias. Second, our study is cross-sectional, thus we cannot make rigorous causal assertions regarding the effects of hormones on health. Attempts were made to reduce bias resulting from temporality issues, by including information only on respondents who had been diagnosed with an outcome after initiating hormone use (or undergoing oophorectomy). However, case information on participants missing data with regard to the date of

diagnosis or the year in which they had started hormone use (n=8) was not excluded. This was deemed appropriate given that we could not determine for certain whether these respondents had been diagnosed with a condition prior to the initiation of hormones. Third, we were unable to measure the effects of multiple hormone use for those on combined hormone regimens, as we could not determine the length of time in which hormones were taken concurrently.

Fourth, our calculations of person-years of hormone use and since oophorectomy are likely overestimated, as we do not know the number of years in which respondents had used each hormone before being diagnosed with a condition. For example, a

participant with 10 years of estrogen use may have been on hormones for only five years before a diagnosis, however all 10 years would be included in person-time estimates. Finally, our use of an in-depth and lengthy survey may have resulted in the over-selection of highly educated trans people, who may have been healthier overall and thus receiving better health care (i.e. obtaining appropriate hormonal regimens and follow-up).

Education has been shown to improve access to care by increasing access to information, enhancing self-esteem, and increasing one’s ability to adopt new health concepts and participate as an equal in client-provider interactions. (63)

6.5 Conclusions

We have drawn attention to the health conditions faced by trans Ontarians, and the characteristics of hormone users. While some adverse effects were reported, most hormone users had not been diagnosed with any outcomes of interest. Surprisingly, one of the more common outcomes was sleep apnea, as six and seven cases were reported among MTF and FTM hormone users, respectively. In fact, we report the largest number of cases in the literature. These findings point to the potential causative role of both

masculinizing and feminizing hormones, adding to trans-health research that suggests androgen use is a significant contributor to the development of sleep apnea. (25, 60)

Thus, future clinical or population-based prospective studies of trans people in Canada should examine not only the independent effects of hormones on sleep apnea (controlling for confounders such as smoking and obesity), but also the specific role of feminizing hormones.

In addition, while high cholesterol and hypertension are commonly reported conditions among hormone users in trans-specific studies, this had not been shown to be a problem among trans Canadians until now. Our study therefore reiterates the need for regular monitoring of the cardiovascular profile of trans patients by health care providers. Overall, we would recommend continual monitoring of the effects of hormones

throughout the period of treatment, as this is consistent with the long-term provision of any type of medication. Evaluations should also include regular screenings for

reproductive cancers, given that long-term exposure of ones gonads/genitalia and breast tissue to cross-sex hormones may contribute to increased risk of malignancies. (34) Lastly, while we have addressed a major gap in the literature, clinical or population-based prospective studies of trans people in Canada would contribute to a better understanding of the long-term health effects of hormones and surgeries.

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