Multiple sclerosis (MS) is a neurological disease with a variety of physical and psychological symptoms.

It sometimes takes a progressive form, with increasing levels of disability. For others, it might take a relapsing-remitting form, with periods of disability alternating with periods of remission.

MS is the number one neurological disease responsible for disability in younger adults.

The exact cause of MS is not known, but doctors believe there are many potential causes working in combination. These might include genetics, viral infections, and environmental triggers.

MS is approximately 3 times more common among the female sex, and the prevalence is rising.

This frequently cited “gender bias” rarely distinguishes between cisgender — that is, people who identify with the sex and gender they were assigned at birth — and transgender people with MS.

If you’re transgender, you might have greater difficulty in finding adequate medical care, and this is especially true if you have a chronic condition such as MS. Let’s take a look at some of the questions you might have about being transgender and having MS.

MS can be a difficult condition to diagnose. It often requires tests to eliminate other conditions with overlapping symptoms, such as lupus. Because MS commonly manifests as the relapsing-remitting variety at the time of diagnosis, you might experience several relapses before you decide to seek treatment. This can further delay your diagnosis.

These issues can be compounded by additional barriers to care if you’re transgender.

In a 2021 study, some sexual and gender minority people living with MS described experiencing gender discrimination within the healthcare system. Some recalled the need to switch doctors, while another experienced aversion and disrespectful remarks from their doctor about questions regarding the effects of hormone therapies on MS symptoms.

MS can sometimes affect sexual function. You may feel hesitant to talk with your doctor about sexual function and gender identity, either due to outside social experiences or because of a non-inclusive clinical environment. This may delay proper diagnosis and appropriate care of these issues.

It can be difficult to find a doctor with whom you’re comfortable talking about transgender healthcare issues, but doing so might help you receive a diagnosis more quickly and access appropriate care.

Gender-affirming hormone therapy might affect your risk of MS or affect disease progression, but more research is needed to determine what those effects might be.

Sex hormones — including testosterone, estrogen, progesterone, and others — may play a role in whether you develop MS, how rapidly it progresses, and the severity of symptoms. This may be due to the effects of sex hormones on the immune system.

A recent review suggested that gender-affirming hormone therapy — particularly estrogens along with testosterone suppression for trans women — might be linked to an inflammatory response and an increased risk for MS.

The review notes that the data to date relies on very few studies with a small number of participants. Larger and more detailed studies are still needed in order to fully understand how transgender hormone therapy might be associated with MS.

There’s evidence to suggest that testosterone does have an effect on MS.

Although every individual’s hormones are different and can change over time, the male sex tends to have higher levels of testosterone at the population level. Testosterone may have properties that allow it to protect the nervous system and reduce inflammation.

This may be one reason that MS is less common among the male sex. Testosterone levels tend to change over time, and these trends correlate with the ages at which males develop MS. Lower levels of testosterone are linked to a higher risk of MS and higher levels of disability.

Some studies have considered testosterone replacement for males who have low testosterone levels as a potential area of research in the treatment of MS.

Like testosterone, estrogen may have an effect on MS.

Some evidence for this is found in people with MS who become pregnant. During pregnancy, people with MS may experience a reduction in symptoms, whereas relapses tend to increase in the postpartum period. This may be due to changes in the immune process during pregnancy. The sex hormones estrogen and progesterone may play a role in mediating the immune process.

There are different types of estrogen, and their individual and combined concentrations form a complex relationship.

Combining anti-inflammatory treatments with estrogen is one potential area of future research for MS treatment.

Disease-modifying therapies (DMTs) for MS are associated with a number of benefits, including reduced symptom severity and slower MS progression.

For these reasons, a person with MS may be interested in taking DMTs. If you’re transgender, you might be concerned about how these therapies are formulated and how they might interact with your body and other concurrent therapies.

While there’s no evidence to suggest that DMTs interact with hormone therapy, these types of interactions have not been studied.

Whether to take DMTs is ultimately your decision to make, and a trusted doctor can help provide information and recommendations in line with your treatment goals.

If you’re transgender, you may experience healthcare-related challenges, and this is true if you have MS as well.

While the causes of MS are not fully understood, experts believe that hormones play a role in the condition’s progression. Because hormone therapy is frequently used by transgender people, this can be an especially complicated intersection to navigate.

You have the ultimate decision-making authority over your own healthcare. Doctors can provide useful information, recommendations, and answers to your questions. Finding a doctor whom you trust might help reduce stress and provide timelier results.