Patient-reported outcomes, provider-reported outcomes, and physiologic parameters after gender-affirming hormone treatment in Canada: a systematic review
Bibliographic record
Abstract
PURPOSE: Canada has experienced a ten-fold increase in referrals for gender-affirming care. Clinical guidelines emphasize the importance of a comprehensive and systematic approach to outcome measurement for gender-affirming hormonal care. However, research is lacking on the investigation of outcomes of Canadian gender-affirming hormonal treatments. METHODS: In total, five databases were searched, as follows: MEDLINE, Embase, PsycINFO, Scopus, and CINAHL on December 26, 2023. To meet inclusion criteria, each study needed to be an original article including patients identifying as transgender or gender diverse (TGD) who were receiving gender-affirming hormonal care in Canada. The Critical Appraisal Skills Programme (CASP) and Joanna Briggs Institute (JBI) tools were used to assess the methodological quality of the study. Descriptive frequencies were calculated for demographic information and a narrative synthesis was conducted to summarize outcomes organized for different treatments. RESULTS: A total of 3315 articles were identified, with 34 articles being included, representing 3990 patients. Physiologic parameters were reported in 62% of the studies and patient-reported outcomes (PROs) in 50%, although only 32% utilized standardized patient-reported outcome measures (PROMs). In studies reporting quantitative results, testosterone treatments showed 80% effectiveness in achieving desired physical changes, while several studies demonstrated that estrogen and antiandrogen treatments improved mental health in 85% of patients. The narrative synthesis of the results reveals positive outcomes and limited adverse effects of gender-affirming hormone therapy; however, it also underscores the need for standardized, consistent outcome measurement tools, particularly PROMs. CONCLUSION: The present systematic review highlights the need for standardized outcome reporting in gender-affirming hormone therapy, underscoring the need for measurement of the patient's perspective through PROMs. Resolving these issues can improve evidence-based practices and support high-quality, patient-centered gender-affirming hormone care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.074 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.005 |
| Bibliometrics | 0.011 | 0.018 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".