Sound Sleep Guru

Sleep and Equity

We know that poor sleep disproportionately affects gender minorities and there is a deficiency in research on sleep in gender minority populations but in particular in transgender and non-binary populations. If you were to conduct a literature search on pubmed today with sleep and transgender you will only get 39 results, with some of them not being applicable.

There are a few excellent publications looking at case reports or studies in limited populations for example in college students.

I’d like to use this post as an opportunity to discuss some of the concerns that have been raised by my transgender patients or that I’ve read about in these rare publications. I’d also like to raise awareness of an important need for research in this area.

Here are some of the things we know:

Case reports have show the AHI changes with hormone use, worsening in the case of androgens and improving with estrogen. However, antedoctally, I’ve seen a worsening with estrogen probably because of the associate weight gain. Currently it is recommended that we screen TG patients using androgens for sleep disordered breathing. I would argue that screening should be done if any hormones are being used.

Hershner et al reported higher rates of mood disorders, sleep disturbances, sleep diagnoses, and suicidality in their 2021 publication in college students. Mental health is an important co-morbidity for sleep in any population and there should be a low threshold for sleep medicine evaluation.

Earl et al summarized the findings with regard to hormone administration in their article published in 2019:

  • Scores of the Pittsburgh sleep quality index worsen
  • Changes in sleep architecture are sleep with more stage 1 sleep

Breast binding, fears about surgery, surgery, stigma, pain, and other psychosocial factors are also important to assess.

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