Clinical challenges in gender transition in a trans man with metabolic syndrome and psychiatric disorders in the context of menopause

Abstract

Gender diversity and related medical interventions have gained greater visibility in recent decades, highlighting the importance of comprehensive approaches to gender affirmation. Initiating gender-affirming hormone therapy (GAHT) in transgender individuals over 50 years of age with multiple comorbidities, such as metabolic syndrome and psychiatric disorders, represents a significant clinical challenge, especially in the postmenopausal context. This report presents the case of a 58-yearold transgender man with a history of bipolar disorder, obesity, and insulin resistance, who began treatment with testosterone gel, gradually adjusted according to clinical response, under continuous and interdisciplinary monitoring. During treatment, mild masculinizing changes, partial stabilization of psychiatric symptoms, and improvements in metabolic parameters were observed. This case highlights the complexity and challenges of implementing interdisciplinary strategies to safely and effectively address the risks associated with hormone therapy in older transgender individuals with significant risk factors.