---
title: "Hormonal Management in Older Transgender and Gender Diverse Adults: Case-Based Considerations"
id: "pubmed-42274359"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42274359"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42274359/"
doi: "10.1210/clinem/dgag231"
published_at: "2026-09-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Hormonal Management in Older Transgender and Gender Diverse Adults: Case-Based Considerations
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42274359
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42274359/)
- **DOI:** [10.1210/clinem/dgag231](https://doi.org/10.1210%2Fclinem%2Fdgag231)
- **Published At:** 2026-09-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The article is an "Approach to the Patient" review focused on **hormonal management** in older transgender and gender diverse (TGD) adults, published in J Clin Endocrinol Metab (2026) by Rothman et al. - It uses a **case-based** framework to highlight management issues when initiating or continuing gender-affirming hormone therapy in the context of aging-related conditions. - Key clinical settings addressed include **neurocognitive disorder**, **increased cardiovascular disease risk**, **prostate cancer**, **bone health**, and **menopause** in older TGD adults. - The authors note that no evidence-based guidelines exist specifically for aging-related conditions in TGD adults; clinical practice is informed by data from studies in both TGD and cisgender adults. - The review synthesizes existing literature and clinical practice to support approaches for the presented patient cases rather than providing new primary data. - The paper emphasizes the growing clinical importance of caring for older TGD adults as population demographics shift toward older age groups. - The abstract identifies major keywords and MeSH topics including **cardiovascular disease**, **neurocognitive decline**, **prostate cancer**, **menopause**, **aging**, and **hormone replacement therapy**. - The authors represent endocrinology and gerontology divisions from University of Colorado, Amsterdam UMC (Vrije Universiteit Amsterdam), and Stanford University. - The review calls for future research to inform best practices and formal clinical guidelines for the care of older TGD adults; specific research priorities were not detailed in the abstract. - Publication identifiers provided in the source include PMID 42274359 and DOI 10.1210/clinem/dgag231. - The article type is a Review and Approach to the Patient that also includes case reports; further methodological and case details were not reported in the abstract shown on PubMed.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, University of Colorado Anschutz, Aurora, CO 80045, USA. * 2 Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, HV 1081, Amsterdam, the Netherlands. * 3 Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. * PMID: **42274359** * DOI: [ 10.1210/clinem/dgag231 ](https://doi.org/10.1210/clinem/dgag231) Item in Clipboard Review # Approach to the patient: cases of hormonal management in older transgender and gender diverse adults Micol S Rothman et al. J Clin Endocrinol Metab. 2026. Show details Display options Display options Format Abstract PubMed PMID J Clin Endocrinol Metab Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Clin+Endocrinol+Metab%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Clin+Endocrinol+Metab%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42274359/) . 2026 Sep 16;111(10):e2281-e2289. doi: 10.1210/clinem/dgag231. ### Authors [Micol S Rothman](https://pubmed.ncbi.nlm.nih.gov/?term=Rothman+MS&cauthor_id=42274359)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42274359/#short-view-affiliation-1 "Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, University of Colorado Anschutz, Aurora, CO 80045, USA."), [Jason O van Heesewijk](https://pubmed.ncbi.nlm.nih.gov/?term=van+Heesewijk+JO&cauthor_id=42274359)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42274359/#short-view-affiliation-2 "Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, HV 1081, Amsterdam, the Netherlands."), [Danit Ariel](https://pubmed.ncbi.nlm.nih.gov/?term=Ariel+D&cauthor_id=42274359)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42274359/#short-view-affiliation-3 "Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA."), [Sean J Iwamoto](https://pubmed.ncbi.nlm.nih.gov/?term=Iwamoto+SJ&cauthor_id=42274359)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42274359/#short-view-affiliation-1 "Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, University of Colorado Anschutz, Aurora, CO 80045, USA.") ### Affiliations * 1 Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, University of Colorado Anschutz, Aurora, CO 80045, USA. * 2 Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, HV 1081, Amsterdam, the Netherlands. * 3 Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. * PMID: **42274359** * DOI: [ 10.1210/clinem/dgag231 ](https://doi.org/10.1210/clinem/dgag231) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract As the general population continues to shift to an older demographic, more transgender and gender diverse (TGD) adults will seek out endocrinologists and other healthcare providers to help them navigate both initiation and continuation of gender-affirming hormone therapy concurrent with the potential development of age-associated diseases. The purpose of this Approach to the Patient article is a case-based approach to management considerations in older TGD adults in the settings of neurocognitive disorder, increased cardiovascular disease risk, prostate cancer, bone health, and menopause. While evidence-based guidelines for these aging-related conditions do not exist specifically for TGD adults, clinical practice and data from studies in TGD and cisgender adults are discussed to support the approaches to these patient cases. Future research in these areas can inform best practices and clinical guidelines for care of older TGD adults. **Keywords:** cardiovascular disease; menopause; neurocognitive decline; older adults; prostate cancer; transgender and gender diverse. © The Author(s) 2026. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults. ](https://pubmed.ncbi.nlm.nih.gov/37113210/) Iwamoto SJ, Defreyne J, Kaoutzanis C, Davies RD, Moreau KL, Rothman MS.Iwamoto SJ, et al.Ther Adv Endocrinol Metab. 2023 Apr 19;14:20420188231166494. doi: 10.1177/20420188231166494. eCollection 2023.Ther Adv Endocrinol Metab. 2023.PMID: 37113210Free PMC article.Review. * [ Feminizing gender-affirming hormone therapy for the transgender and gender diverse population: An overview of treatment modality, monitoring, and risks. ](https://pubmed.ncbi.nlm.nih.gov/36403287/) Sudhakar D, Huang Z, Zietkowski M, Powell N, Fisher AR.Sudhakar D, et al.Neurourol Urodyn. 2023 Jun;42(5):903-920. doi: 10.1002/nau.25097. Epub 2022 Nov 20.Neurourol Urodyn. 2023.PMID: 36403287Review. * [ Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research. ](https://pubmed.ncbi.nlm.nih.gov/38713697/) Ho TF, Zenger B, Mark B, Hiatt L, Sullivan E, Steinberg BA, Lyons A, Spivak AM, Agarwal C, Adelman M, Hotaling J, Kiraly B, Talboys S.Ho TF, et al.PLoS One. 2024 May 7;19(5):e0302895. doi: 10.1371/journal.pone.0302895. eCollection 2024.PLoS One. 2024.PMID: 38713697Free PMC article. * [ Rapid Review of Gender-Affirming Healthcare for Children and Adolescents: Evidence Synthesis (2021-2025) and Recommendations for South Africa. ](https://pubmed.ncbi.nlm.nih.gov/41510248/) Dunkle KL, Lynch I, Adams K, Brouard P, de Beer-Procter JL, Dyers R, Mabenge L, Matthyse L, McLachlan C, Msweli S, Stevens M, Venter FWD, de Vries E.Dunkle KL, et al.Res Sq [Preprint]. 2025 Dec 9:rs.3.rs-8253372. doi: 10.21203/rs.3.rs-8253372/v1.Res Sq. 2025.Update in: [South Afr J HIV Med. 2026 Aug 28;27(1):1800. doi: 10.4102/sajhivmed.v27i1.1800.](https://pubmed.ncbi.nlm.nih.gov/42699451/)PMID: 41510248Free PMC article.Updated.Preprint. * [ Barriers and Facilitators to Gender-affirming Hormone Therapy in the Veterans Health Administration. ](https://pubmed.ncbi.nlm.nih.gov/37436725/) Wolfe HL, Boyer TL, Shipherd JC, Kauth MR, Jasuja GK, Blosnich JR.Wolfe HL, et al.Ann Behav Med. 2023 Nov 16;57(12):1014-1023. doi: 10.1093/abm/kaad035.Ann Behav Med. 2023.PMID: 37436725 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42274359) ## 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