Clinical Pharmacology & Therapeutics | 2021
Commentary on “Sex and Gender Differences in Clinical Pharmacology: Implications for Transgender Medicine”
Abstract
In this journal in 2000, Kim et al., published a commentary titled “Is it sex or is it gender.” The piece differentiated the two related yet distinct terms and how correct usage is critical to the scientific literature. Kim et al., described the two terms in this way “sex is the biological difference between men and women that is hormonal and reproductive in nature, whereas gender describes variability between men and women in society, culture, or history.” This article eloquently described when the terms are applicable, when they may be used in concert, and the potential consequences when they are used interchangeably even by health authorities. Kim et al. discussed how a clinical pharmacologist needs to be aware of their appropriate usage and the potential interplay of various associated intrinsic (e.g., genetics and sexspecific physiologic factors) and extrinsic (e.g., environment, smoking/drinking, and diet) factors that may be involved. Fast forwarding 21 years, we need to take a close look at the intersection of the terms sex and gender to ensure we are thinking about the general population holistically and not just in a binary way. Are we considering all aspects of the population? In this issue, Cirrincione and Huang review a timely and important aspect of sex and gender differences in clinical pharmacology, that of the implications of transgender medicine. According to the Mayo Clinic, transgender is “an umbrella term used to capture the spectrum of gender identity and genderexpression diversity. It includes: those who have a gender identity that differs from the sex assigned to them at birth; those whose gender expression— the way gender is conveyed to others through clothing, communication, mannerisms and interests— and behavior don’t follow stereotypical societal norms for the sex assigned to them at birth; and those who identify and express their gender fluidly outside of the gender binary, which might or might not involve hormonal or surgical procedures.” Cisgender refers to a person who identifies their gender to be the same as the sex they were assigned at birth. Cirrincione and Huang note that in the United States, the populationbased estimates of transgender adults is between 0.5 and 0.7% depending on age, and in one study it was approximated that 70% reported taking hormonal based regimens. On Census.gov, the current US population is estimated to be over 330 million people. That leads to an estimate of 1.6 to 2.3 million transgender individuals in the United States, with up to ~ 1.6 million of them currently receiving hormonal regimens. It is also anticipated that the overall transgender population will grow in size. Over the years, the medical field has adapted to the needs of this increasing population and it is evident as most large medical centers in the United States have a transgender care center that is focused on supporting those in the community. However, access to these centers can be challenging for some individuals based on geographical and financial issues. Transgender medicine is an evolving specialty that is crossdisciplinary in nature and can involve primary care physicians, endocrinologist, ear, nose, and throat (ENT) specialists, urologists, gynecologist, cosmetic surgeons, along with various other physical and mental health specialists, depending on the needs of the individual. Not surprisingly, hormonal regimens are the mainstay of treatment. The Endocrine Society has published guidelines on the use of hormonal regimens for transgender men and transgender women (Table 1) and has even published a Transgender