User:KevP25/Transgender hormone therapy/Amcclanahan Peer Review

General info

Whose work are you reviewing?

KevP25

Link to the current version of the article (if it exists)

Transgender hormone therapy

Peer Review

I utilized Wikipedia's Peer Review template, which breaks peer review down into these categories:

Lead

• The term 'gender-affirming hormone therapy' replaced the less specific and outdated 'hormone therapy' that existed in the previous edition of the article.
• The Lead portion of this article is concise and not overly detailed, as recommended by Wikipedia.
• The use of gender-affirming hormone therapy in the context of intersex individuals is helpful to keep in this Lead portion, because it offers readers another common indication for hormone therapy, aside from gender dysphoria.
• Suggestion: in your Workplan, you mention expanding on the different definitions of gender identity here. Do you still plan on commenting on this in the Lead section or did you decide against it?

Content

• Requirements section
  • It is helpful that geographic and institution-specific differences are highlighted, as well as the different medical subspecialties that prescribe gender affirming therapies. Maybe readers would find it helpful to read about these specialties through a hyperlink. You could link these three specialties to their respective Wikipedia pages by highlighting them and clicking the chain to the left of the Cite button.
  • The third paragraph is much more clear to me after the edits that it underwent, with the International Journal of Transgenderism SOC. It paints a clear picture that either a mental health professional OR a hormone provider specialized in transgender care can evaluate a patient for gender dysphoria. It also comments well on the SOC's recommendation of controlling comorbidities prior to initiating gender-affirming hormone therapy.
  • The final sentence of the Requirements section above Gender dysphoria refers to the two approaches, I believe: requiring a therapist's sign off and the informed consent model. Do I have that correct?
  • Gender dysphoria subsection:
    • This content was added and is a welcomed addition to the flow of this section.
    • It includes a definition of gender dysphoria, its prerequisite relation to gender-affirming therapy, as well as common comorbidities seen with it.
• Treatment options section
  • To me, it seems very important that global readers make sense of the variance in these treatment options, as they
  • Delaying puberty in adolescents subsection:
    • This entire subsection was added based on evolving treatment paradigms in this space. WPATH recommendations make up most of this section, and given their recommendations, it is important to have this subsection here.
    • Seeing as WPATH emphasizes puberty-suppressing hormone therapy as reversible, this treatment option contrasts nicely with the others, which are more permanent.
  • Feminizing hormone therapy subsection:
    • The addition of various routes of estrogen therapy, with a citation, flows well here given that the same was previously done for testosterone in masculinizing therapy (oral, IM, subcutaneous injections, etc.).
    • I like how the author elaborated on what desired secondary female sex characteristics are. in the second to last paragraph here. It saves the reader from having to enter another article to seek out an understanding of those.
    • Only question I have, largely due to my ignorance, is are 'female' and 'feminine' used interchangeably in the context of secondary sex characteristics? I notice the same with 'masculine' in the next section.
  • Masculinizing hormone therapy subsection:
    • Citation 11 adds an interesting caveat to masculinizing hormone therapy. Neat that this detail about inhibiting estrogen was added.
    • The addition of the final paragraph, where masculine secondary sex characteristics are added provides nice balance to the feminizing hormone therapy subsection, which mentions the same of feminine secondary sex characteristics.
• Safety section:
  • Charts of the SOC summary of risks of both feminizing and masculinizing hormone therapy are welcomed additions to this portion of the article, as well as to the article in general.
  • Under Masculinizing hormone therapy, do you mean to title the chart "Summary of Risks of Testosterone Therapy"?
  • Awesome charts!

Tone and Balance

• My opinion is that the article has an objective flow and tone to it. Never once reading it did I feel as if any of the cumulative authors were trying to sway the reader in any particular direction.
• Relying on guidelines and recommendations, as opposed to primary research studies, aids in the objective feel to this article.
• The recent additions to the article provide strong accompanying details to what was already there, just with more recent updates. This is challenging to do in a topic that is as rapidly evolving as Transgender hormone therapy.

Sources and Resources

• As mentioned, I like how this article focuses on guidelines from trusted sources in the realm of transgender patient care, as opposed to primary research articles. Many of these sources come from the World Professional Association for Transgender Health.
• The citations that were added backed up the claims that were clarified in the article, without copying them word for word.

Organization

• The overall architecture of this article is well thought out. The added subsections were improvements to the organization of the article, in my view.
• The five main sections as it stands right now are: Requirements, Treatment options, Safety, Treatment eligibility, and Accessibility. I will be curious to see how this evolves over the future.

Images and Media

• As mentioned, I like the inclusion of the charts from the SOC citation. Nothing keeps the attention of someone reading a block of text better than a figure or chart!

Overall impressions

• My observation in this peer review is that the article has undergone fruitful changes. These changes include updated guidelines and recommendations on definitions and terminology ("gender-affirming hormone therapy", addition of gender dysphoria paragraph, medical subspecialties qualified for care of transgender patients, etc.), the mechanism and risks of both feminizing and masculinizing hormone therapy, and the addition of a paragraph on a previously unmentioned treatment strategy: delaying puberty in adolescents.
• It is my understanding that these updates and changes are in accordance with guidelines from the World Professional Association for Transgender Health and other trusted sources.
• I have included a few suggestions in the write-up above where I felt like this article could have benefitted slightly more, but please take these as constructive critiques!