This Approach to the Patient review, published in J Clin Endocrinol Metab (2026) by Rothman et al., examines clinical considerations for gender-affirming hormone therapy in older transgender and gender diverse (TGD) adults. The article responds to a demographic shift toward an older population and the resulting increase in TGD adults who require endocrine care while also developing age-associated conditions. Publication identifiers listed in the source include PMID 42274359 and DOI 10.1210/clinem/dgag231.
The authors adopt a case-based format to illustrate management considerations when initiating or continuing hormonal therapy in older TGD adults. The stated purpose is to present clinical approaches across several age-associated conditions: neurocognitive disorder, increased cardiovascular disease risk, prostate cancer, bone health, and menopause. The review integrates clinical practice experience with available data from studies in both TGD and cisgender populations to support the approaches used in the patient cases.
Neurocognitive disorder (as an age-associated condition) is one of the clinical contexts discussed in the case-based article. The source indicates that the review addresses how clinicians might approach hormonal management in older TGD adults who develop neurocognitive impairment, but specific case details, management algorithms, or evidence summaries were not reported in the PubMed abstract portion of the source.
The review highlights cardiovascular disease risk as a major consideration when providing gender-affirming hormone therapy to older adults. The authors discuss integrating available data from TGD and cisgender studies to inform care, recognizing that evidence-based guidelines specific to TGD older adults are lacking. The abstract does not provide details on screening, risk stratification, or modifications to hormonal regimens—those specifics would be found in the full text.
Prostate cancer is identified as a key scenario explored in the article. The review uses case examples to address hormonal management when prostate neoplasms are present or a concern in TGD adults assigned male at birth. The PubMed abstract notes the topic but does not report the clinical recommendations or case outcomes; readers must consult the full article for detailed guidance.
Bone health is included among the age-related conditions discussed in relation to ongoing or initiating gender-affirming hormones. The abstract indicates the review considers bone-related issues in older TGD adults, synthesizing data from relevant studies, but it does not provide specific diagnostic thresholds, treatment strategies, or monitoring intervals in the abstract view.
Menopause and its intersection with gender-affirming care in older TGD adults are addressed in the article. The abstract lists menopause among the clinical settings considered, acknowledging the need to reconcile menopause-related management with gender-affirming hormone approaches. Specific clinical details for menopause care in TGD patients were not reported in the PubMed abstract.
A central theme of the review is the absence of evidence-based, aging-specific guidelines for TGD adults. The authors state that clinical practice must currently rely on a combination of existing data from TGD and cisgender studies plus clinician experience. The abstract emphasizes the need for future research to inform best practices and to support formal guideline development; the abstract does not enumerate prioritized research questions or study designs.
The article lists Micol S Rothman, Jason O van Heesewijk, Danit Ariel, and Sean J Iwamoto as authors with affiliations to University of Colorado, Amsterdam UMC (Vrije Universiteit Amsterdam), and Stanford University. Article type is Review and Approach to the Patient, with MeSH indexing including Aged, Aging, Cardiovascular Diseases, Prostatic Neoplasms/therapy, Hormone Replacement Therapy/methods, Transgender Persons, and related terms. For clinical application or protocol-level detail, the full text should be consulted because the PubMed abstract summarizes scope and intent but does not report case specifics, treatment regimens, monitoring parameters, or outcome data.