Dr Wellons works closely with her patients to identify and quantify the benefits and risks of hormonal therapy and weigh them against each other. At present, there are no prospective studies that have investigated mortality rates in transgender men. Yet, there are many potential risks and cardiometabolic issues that need to be investigated.
‘Trans Buddy’ Program May Help Clinicians and Patients
“My practice is definitely growing. I don’t know if this is a blip or if I will see a steady rise in patients. More and more resources for this group of patients are emerging at Vanderbilt University Medical Center. That suggests to me that I will see a steady rise,” said Dr Wellons. “We have a ‘trans buddy’ program that I am especially appreciative of. These buddies join patients at clinic visits to make the patient as comfortable as possible in an often uncomfortable circumstance.”
She noted that these types of buddies are great resources for endocrinologists. While they do not provide gold-standard, peer-reviewed, epidemiologic evidence, they do offer a boots-on-the-ground update on what they are seeing in their communities.
“My transgender patients definitely want more information on what kind of physical changes they can expect given their unique characteristics. They want information personalized to them. But that personalized information can only be given after treatment, careful monitoring, and analysis of large numbers of patients,” said Dr Wellons. “I am an endocrinologist and an internist, and I am a product of that training. I am going to focus on outcomes like mortality and cardiovascular disease and cancer because I have a lot of experience thinking about those outcomes. Those are well-accepted and quantifiable causes of suffering. I do not want to cause these bad outcomes in my patients. The existential ‘who am I’ and ‘who am I supposed to be’ types of suffering that are alleviated with hormonal therapy — I am not as good at quantifying those.”
- Irwig DS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol. 2016. doi:10.1016/S2213-8587(16)00036-X.
- Conron KJ, Scott G, Stowell GS, Landers SJ. Transgender health in Massachusetts: results from a household probability sample of adults. Am J Public Health. 2012;102(1):118-122. doi:10.2105/AJPH.2011.300315.
- Irwig MS. Transgender care by endocrinologists in the United States. Endocr Pract. 2016. doi:10.4158/EP151185.OR.