Sex and Gender Differences in Clinical Pharmacology: Implications for Transgender Medicine

Clin Pharmacol Ther. 2021 Oct;110(4):897-908. doi: 10.1002/cpt.2234. Epub 2021 May 2.

Abstract

The transgender adult population is growing globally, but clinical pharmacology has lagged behind other areas of transgender medicine. Medical care for transgender adults may include long-term testosterone or estrogen treatment to align secondary sex characteristics with gender identity. Clinicians often use drug-drug interaction data from the general adult population to predict medication disposition or safety among transgender adults. However, this approach does not address the complex pharmacodynamic effects of hormone therapy in transgender adults. In this review, we critically examine sex-related and gender-related differences in clinical pharmacology and apply these data to discuss current gaps in transgender medicine.

Publication types

  • Review

MeSH terms

  • Androgens / pharmacology*
  • Androgens / therapeutic use
  • Body Composition / drug effects
  • Body Composition / physiology
  • Cytochrome P-450 Enzyme System / drug effects*
  • Cytochrome P-450 Enzyme System / metabolism
  • Drug Interactions
  • Drug-Related Side Effects and Adverse Reactions
  • Estrogens / pharmacology*
  • Estrogens / therapeutic use
  • Female
  • Glucuronosyltransferase / drug effects*
  • Glucuronosyltransferase / metabolism
  • Humans
  • Intestinal Absorption / drug effects
  • Intestinal Absorption / physiology
  • Male
  • Pharmacology, Clinical
  • Renal Elimination / drug effects
  • Renal Elimination / physiology
  • Sex Factors
  • Testosterone / therapeutic use
  • Tissue Distribution / drug effects
  • Tissue Distribution / physiology
  • Transgender Persons*

Substances

  • Androgens
  • Estrogens
  • Testosterone
  • Cytochrome P-450 Enzyme System
  • Glucuronosyltransferase