Considerations in Care of the Transgender Orthopedic Patient

Purpose of Review Transgender and gender diverse (TGD) patients, those with a gender identity different from their sex assigned at birth, are a growing population with specific orthopedic needs based on the use of gender-affirming hormonal and surgical therapies. This article outlines the current understanding of musculoskeletal basic science, clinical management considerations and translational applications that influence orthopedic care for TGD patients. In addition, this review highlights pertinent United States health policy changes that may affect TGD health outcomes including access to gender-affirming care and athletic participation. Recent Findings TGD patients comprise a small but growing percentage of the population, yet experience significant barriers to health care. Both receipt of gender-affirming care and physical activity have been shown to improve mental health comorbidities in the TGD population. Since 2021, however, a rise in national and state-level policies have restricted healthcare access for TGD patients and their participation in athletic events. Limited collection of sexual orientation and gender identity (SOGI) data hinders the generation of population-level clinical evidence for TGD patients within Orthopedics. Despite this, early evidence suggests that estrogen-based and testosterone-based GAHT have a neutral to positive effect on bone health and fracture risk for TGD adults. Summary Further clinical research is needed to define injury patterns in other Orthopedic subspecialties. Despite this, findings extrapolated from basic science and other surgical subspecialties can enable orthopedic providers to engage in evidence-based shared clinical decision-making and patient-centered care.