Many pre-existing conditions that are closely monitored for folx on HRT are also present at higher rates among Black, Indigenous, and other Persons of Color (BIPOC) communities.
As we’ve seen with COVID, our healthcare systems do not care for BIPOC bodies as well as they care for white bodies. Unfortunately, this systemic inequality existed well before our current pandemic. Part of the work here at FOLX is to ensure we are seeing people as their full selves, including the persistent racism some people face day-in-and-day out.
In the US, people who are identified as Black, Hispanic/Latinx/Latine, and/or American Indian/Alaskan Native have higher rates of diabetes and high blood pressure than those who identify as white. A 2011 study found that while there don’t appear to be racial disparities in rates of high cholesterol, white people with high cholesterol are more likely to have it well-controlled by medication. Some people wrongly assume that this is due to genetic differences based on race. However, recent research reveals that these health disparities are not due to race, but racism.
Racism can be defined as “prejudice, discrimination, or antagonism directed against a person or people on the basis of their membership in a particular racial or ethnic group.” This discrimination shows up in places like our criminal justice, education, and health care systems.
In a 2019 literature review, a group of researchers discuss three ways that racism leads to inequities in health:
Two of the most commonly prescribed medications for HRT, estrogen and testosterone, can cause changes in many different parts of the body, including the blood and blood vessels. While both instances of these are fairly uncommon, there is a risk of estrogen or testosterone increasing the risk for certain health conditions. For those who don’t have preexisting health conditions or family history, these risks are low.
As a consequence of racism and transphobia, BIPOC on HRT are more likely to have pre-existing conditions that increase the risk for heart attacks and strokes. Estrogen and testosterone can enhance those risks:
Sharing all of this information is not meant to deter anyone from pursuing HRT. Here at FOLX, we want to make sure that everyone understands the risks associated with taking all of the medications we prescribe. That’s why our intake forms include questions about conditions like diabetes, high blood pressure, and high cholesterol along with information on how those conditions may be impacted by HRT.
We do not automatically exclude anyone with those conditions, for many reasons including the disproportionately high negative impact it would have on BIPOC members of our community. And since we deeply value informed consent, every FOLX member has the opportunity to meet with one of our clinicians to discuss their personal risk in more detail along with lifestyle changes that may help decrease those risks.
Ultimately: it’s about understanding the body, acknowledging why a condition might be the case, and making a plan with a provider to safely take and monitor hormone levels, and FOLX closely monitors members’ testosterone labs and estrogen labs.
For those who want to know more about how to decrease their personal risk, our FOLX member advocates are happy to help source answers before starting, and our FOLX clinicians are available whenever a member needs. Don't hesitate to reach out at email@example.com.