Transgender people and occupational diving: a new challenge for diving physicians?

The gender identity of transgender people is not fully aligned with their sex assigned at birth. It has been estimated that approximately 355 of 100,000 people in the general population consider themselves transgender. Transgender people are increasingly choosing to transition through gender-affirming hormone therapy, including treatment with testosterone or oestrogens and gender-affirming surgeries. Occupational diving is performed in a unique, highly hostile physiological environment. An occupational diver should be free of pulmonary, cardiovascular, neurological, and psychological risk factors that could increase the risk of diving-associated adverse events. Dive medical assessments can identify these risk factors. The increasing number of people openly identifying as transgender raises the likelihood that more will want to participate in occupational diving. To date, however, no guidelines have been specifically designed for safe occupational diving by transgender individuals. This review, involving 43 systematic reviews and/or meta-analyses, was therefore designed to assess the long-term health effects in transgender individuals and how these influence occupational diving. Although transgender people face some additional health risks that could affect occupational diving, these risks can be managed by adhering to regular occupational fitness-to-dive guidelines.