Milionis C, Zoumakis E, Tselebis A, Ilias I. Endocrine issues in critically ill transgender patients: A narrative review. World J Crit Care Med 2025; 14(3): 100660 [DOI: 10.5492/wjccm.v14.i3.100660]
Corresponding Author of This Article
Ioannis Ilias, MD, PhD, Director, Department of Endocrinology, Hippocration General Hospital, 63 Evrou Street, Athens GR-11527, Greece. iiliasmd@yahoo.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Sep 9, 2025; 14(3): 100660 Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.100660
Endocrine issues in critically ill transgender patients: A narrative review
Charalampos Milionis, Emmanouil Zoumakis, Athanasios Tselebis, Ioannis Ilias
Charalampos Milionis, Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General Hospital, Athens 11521, Greece
Emmanouil Zoumakis, First Department of Pediatrics, University of Athens Medical School, Agia Sofia Hospital, Athens GR-11527, Greece
Athanasios Tselebis, Department of Psychiatry, “Sotiria” General Chest Diseases Hospital, Athens GR-11527, Greece
Ioannis Ilias, Department of Endocrinology, Hippocration General Hospital, Athens GR-11527, Greece
Author contributions: Milionis M and Ilias I conceived and designed this work; Milionis M, Zoumakis E, Tselebis A, and Ilias I researched the literature, wrote the manuscript; all of the authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ioannis Ilias, MD, PhD, Director, Department of Endocrinology, Hippocration General Hospital, 63 Evrou Street, Athens GR-11527, Greece. iiliasmd@yahoo.com
Received: August 22, 2024 Revised: February 25, 2025 Accepted: March 4, 2025 Published online: September 9, 2025 Processing time: 330 Days and 5.8 Hours
Abstract
Transgender individuals often undergo gender-affirming hormonal therapy (GAHT) to align their physical characteristics with their gender identity, which introduces unique challenges in the management of critically ill patients. In the setting of critical illness, the interactions between GAHT and the body's endocrine response are complex. GAHT can influence the hypothalamic-pituitary-adrenal axis, sex hormone levels, and metabolic parameters, potentially complicating the clinical picture. For example, estrogen therapy in transgender women increases the risk of venous thromboembolism, which is further exacerbated by the immobility and hypercoagulable state often present in critically ill patients. Testosterone therapy in transgender men can lead to erythrocytosis, increasing the risk of thromboembolic events during critical illness. The potential for drug interactions, particularly with medications used in the intensive care unit, also requires careful consideration. Monitoring hormone levels and adjusting GAHT in the acute setting are crucial, although evidence-based guidelines are lacking. The need for individualized care and vigilant monitoring of endocrine and metabolic parameters is paramount to improve outcomes in this vulnerable population.
Core Tip: Critically ill transgender patients receiving gender-affirming hormone therapy present unique challenges in the intensive care unit, particularly regarding the increased risks of venous thromboembolism, erythrocytosis, and potential drug interactions. Understanding and managing these endocrine alterations are essential for optimizing care and improving outcomes in this vulnerable population.
