Guidance on calculating doses of antineoplastic agents for transgender and gender-expansive patients taking gender-affirming hormone therapy

<h2>Abstract</h2><h3>Background</h3> There is currently no formal guidance for calculating chemotherapy in transgender and gender-expansive patients taking gender-affirming hormone therapy (GAHT). It is necessary to develop a method that ensures that chemotherapy dosing and treatment are both safe and effective in this population. <h3>Objectives</h3> To identify guidance for clinicians to evaluate renal function to determine appropriate chemotherapy doses in transgender and gender-expansive adult patients taking GAHT. <h3>Methods</h3> The Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+) Clinical Advisory Committee at a large comprehensive cancer center conducted an unstructured review in PubMed to identify current literature surrounding chemotherapy and medication dosing in patients taking GAHT. <h3>Results</h3> The use of sex assigned at birth-dependent methods to define renal dosing may not be accurate for transgender and gender-expansive patients. Based on the limited published literature, a multidisciplinary team developed guidance on calculating chemotherapy dosing in patients who are taking GAHT. Gaps not addressed by available literature were evaluated by a panel of experts, and their recommendations were included. <h3>Conclusion</h3> A guideline was produced based on the available data; however, additional research is needed to better define the physiologic changes that occur with GAHT and how those changes affect renal function and current surrogates that are used to estimate renal function.