Background: A better understanding of MS outcomes in transgender and gender-diverse (TGD) people with MS (PwMS), including those undergoing gender-affirming hormone therapy (GAHT), would improve the clinical care of this underrepresented population and deepen understanding of how exogenous sex hormones may impact MS.
Objective: To characterize a cohort of TGD PwMS, describe changes in MS disease activity and outcomes following GAHT, and identify potential gaps in clinical management or social drivers of health (SDoH) in this population.
Methods: A multicenter retrospective review was performed on TGD PwMS medical record data to record their relevant demographic, gender identity, and clinical information.
Results: Twenty-two TGD PwMS were identified, 21 were assigned female at birth (AFAB). They had a wide range of gender identities and reproductive histories. Overall, MS disability was mild: median EDSS score was 1.5 and no individuals required ambulatory assistance. Testosterone as GAHT was not associated with clinical relapses, disability progression, Timed 25-Foot Walk slowing, or new radiologic disease activity.
Conclusion: The current findings, that a well-educated, well-insured TGD PwMS cohort (primarily AFAB) on high-efficacy disease-modifying therapy (DMT) had overall mild disease, provides reassurance for TGD about their MS disease trajectory and did not detect any concerns regarding exogenous testosterone.
Keywords: Multiple sclerosis; gender diverse; gender-affirming hormone therapy; social drivers of health; transgender.