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Zeigler G, Harrington CA, Rosendale N, Ganos C, Roldan V, Pace A, Alick-Lindstrom S, Orozco-Poore C, Deeb W, Hansen ML, L'Erario ZP. Neurologic Care for Transgender and Gender-Diverse People: A Review of Current Evidence and Clinical Implications. Neurol Clin Pract 2024; 14:e200332. [PMID: 38919931 PMCID: PMC11195436 DOI: 10.1212/cpj.0000000000200332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 06/27/2024]
Abstract
Purpose of Review To summarize the literature on neurologic care for transgender and gender-diverse (TGD) people and provide implications for clinical practice. Recent Findings There are limited data on the frequency and management of neurologic conditions among TGD people. TGD people have a higher prevalence of various neurologic conditions compared with cisgender or general population cohorts, including migraine, subjective cognitive decline, sleep disturbances, functional disorders, and cerebrovascular disease. Gender-affirming hormone therapy interacts with commonly prescribed neurologic medications and increases stroke risk among transfeminine people. Sex hormones and sex chromosomes may play a role in neurodegeneration and disability progression in neuroimmunologic diseases. Clitoral reduction surgeries on intersex children can cause neurologic disability and sexual dysfunction in adulthood. Socioeconomic disparities among TGD people contribute to health care barriers. Summary Neurologists should consider the unique experiences and health care needs of TGD people in their clinical practice and research protocols.
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Affiliation(s)
- Gwen Zeigler
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Cole A Harrington
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Nicole Rosendale
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Christos Ganos
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Valeria Roldan
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Anna Pace
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Sasha Alick-Lindstrom
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Casey Orozco-Poore
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Wissam Deeb
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Margaret L Hansen
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Z Paige L'Erario
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
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