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Lee KMN, Rushovich T, Gompers A, Boulicault M, Worthington S, Lockhart JW, Richardson SS. A Gender Hypothesis of sex disparities in adverse drug events. Soc Sci Med 2023; 339:116385. [PMID: 37952268 DOI: 10.1016/j.socscimed.2023.116385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/06/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023]
Abstract
Pharmacovigilance databases contain larger numbers of adverse drug events (ADEs) that occurred in women compared to men. The cause of this disparity is frequently attributed to sex-linked biological factors. We offer an alternative Gender Hypothesis, positing that gendered social factors are central to the production of aggregate sex disparities in ADE reports. We describe four pathways through which gender may influence observed sex disparities in pharmacovigilance databases: healthcare utilization; bias and discrimination in the clinic; experience of a drug event as adverse; and pre-existing social and structural determinants of health. We then use data from the U.S. FDA Adverse Event Reporting System (FAERS) to explore how the Gender Hypothesis might generate novel predictions and explanations of sex disparities in ADEs in existing widely referenced datasets. Analyzing more than 3 million records of ADEs between 2014 and 2022, we find that patient-reported ADEs show a larger female skew than healthcare provider-reported ADEs and that the sex disparity is markedly smaller for outcomes involving death or hospitalization. We also find that the sex disparity varies greatly across types of ADEs, for example, cosmetically salient ADEs are skewed heavily female and sexual dysfunction ADEs are skewed male. Together, we interpret these findings as providing evidence of the promise of the Gender Hypothesis for identifying intervenable mechanisms and pathways contributing to sex disparities in ADEs. Rigorous application of the Gender Hypothesis to additional datasets and in future research studies could yield new insights into the causes of sex disparities in ADEs.
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Affiliation(s)
- Katharine M N Lee
- Tulane University, Department of Anthropology, 101 Dinwiddie Hall, 6823 St. Charles Ave., New Orleans, LA, 70118, USA.
| | - Tamara Rushovich
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Annika Gompers
- Emory University Rollins School of Public Health, Department of Epidemiology, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Marion Boulicault
- Massachusetts Institute of Technology, Department of Linguistics and Philosophy, 77 Massachusetts Ave, Cambridge, MA, 02139, USA; University of Edinburgh, School of Philosophy, Psychology and Language Sciences, 40 George Square, Edinburgh, EH8 9JX, UK.
| | - Steven Worthington
- Institute for Quantitative Social Science, Harvard University, 1737 Cambridge Street, Cambridge, MA, 02138, USA
| | - Jeffrey W Lockhart
- University of Chicago, Social Sciences Division, 1155 E. 60th St., Chicago, IL, 60637, USA.
| | - Sarah S Richardson
- Department of the History of Science, Harvard University, 1 Oxford Street, Cambridge, MA, 02138, USA; Committee on Degrees in Studies of Women, Gender, and Sexuality, Boylston Hall, Harvard University, Cambridge, MA, 02138, USA.
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2
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Gao JL, Streed CG, Thompson J, Dommasch ED, Peebles JK. Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics. J Am Acad Dermatol 2023; 89:774-783. [PMID: 34756934 DOI: 10.1016/j.jaad.2021.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team.
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Affiliation(s)
- Julia L Gao
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.
| | - Carl G Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts; Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts
| | | | - Erica D Dommasch
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jon Klinton Peebles
- Department of Dermatology, Kaiser-Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
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3
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Tang GT, Zwickl S, Sinclair R, Zajac JD, Cheung AS. Effect of gender-affirming hormone therapy on hair growth: a systematic review of the literature. Clin Exp Dermatol 2023; 48:1117-1127. [PMID: 37311161 DOI: 10.1093/ced/llad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023]
Abstract
Gender-affirming hormone therapy (GAHT) leads to changes in body composition, secondary sex characteristics and in the distribution and pattern of hair growth. Transgender individuals undergoing GAHT may experience altered hair growth patterns that may be affirming and desirable, or undesirable with a subsequent impact on their quality of life. Given increasing numbers of transgender individuals commencing GAHT worldwide and the clinical relevance of the impact of GAHT on hair growth, we systematically reviewed the existing literature on the impact of GAHT on hair changes and androgenic alopecia (AGA). The majority of studies used grading schemes or subjective measures of hair changes based on patient or investigator's examination. Very few studies used objective quantitative measures of hair parameters but demonstrated statistically significant changes in hair growth length, diameter and density. Feminizing GAHT with estradiol and/or antiandrogens in transgender women may reduce facial and body hair growth and also can improve AGA. Masculinizing GAHT with testosterone in transgender men may increase facial and body hair growth as well as induce or accelerate AGA. The impact of GAHT on hair growth may not align with a transgender person's hair growth goals and specific treatment for AGA and/or hirsutism may be sought. Further research on how GAHT affects hair growth is required.
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Affiliation(s)
- Gia Toan Tang
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Sav Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
| | | | - Jeffrey D Zajac
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
| | - Ada S Cheung
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
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4
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Gao JL, Sanz J, Tan N, King DS, Modest AM, Dommasch ED. Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study. J Am Acad Dermatol 2023; 89:504-510. [PMID: 36780950 DOI: 10.1016/j.jaad.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. OBJECTIVE We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. METHODS Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. RESULTS TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). LIMITATIONS Inability to determine causation and limited generalizability. CONCLUSION TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men.
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Affiliation(s)
- Julia L Gao
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Dartmouth Health, Lebanon, New Hampshire; George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Jessika Sanz
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; New York Institute College of Osteopathic Medicine, Jonesboro, Arkansas
| | - Nicholas Tan
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Case Western University School of Medicine, Cleveland, Ohio
| | - Dana S King
- Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Erica D Dommasch
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Rutnin S, Suchonwanit P, Kositkuljorn C, Pomsoong C, Korpaisarn S, Arunakul J, Rattananukrom T. Characterizing Dermatological Conditions in the Transgender Population: A Cross-Sectional Study. Transgend Health 2023; 8:89-99. [PMID: 36824384 PMCID: PMC9942180 DOI: 10.1089/trgh.2021.0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to demonstrate the effects of gender-affirming hormone therapy (GAHT) and gender-affirming procedures on the skin in transgender individuals. Methods We conducted a cross-sectional study among transgender people. Skin conditions related to GAHT were assessed, including acne (using the Investigator's Global Assessment, IGA), postacne sequelae, melasma, hypertrichosis in androgen-sensitive areas (HAAs) in transgender men (TM) and hirsutism in transgender women (TW) (using the modified Ferriman-Gallwey score, mFG score), and hair loss (using the Hamilton-Norwood and Ludwig scale) at baseline, 6 months after GAHT, and the day on which the questionnaire was completed. Dermatological problems after gender-affirming procedures were evaluated. Results A total of 159 patients, including 134 TM and 25 TW, were eligible to participate. The median duration of GAHT was 23 and 36 months in TM and TW, respectively. In TM, the median IGA score of facial acne increased from 1 at baseline to 3 after 6 months and decreased to 2 after 2 years of GAHT. The mFG score indicated HAA in all TMs after testosterone treatment. A total of 88.1% of TM had no hair loss before hormone therapy. However, after 2 years of GAHT, 76.1% of TM developed male pattern hair loss (MPHL), and 26.1% of them had moderate-to-severe MPHL. In TW, the median IGA and mFG scores decreased after 3 years of hormone therapy, and the proportion of female pattern hair loss (FPHL) in TW increased to 16% after GAHT. In both groups, the most common skin complication after gender-affirming surgery was hypertrophic scarring. Conclusions GAHT in TM resulted in acne and MPHL, whereas GAHT in TW caused melasma and FPHL.
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Affiliation(s)
- Suthinee Rutnin
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cherrin Pomsoong
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sira Korpaisarn
- Divisions of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jiraporn Arunakul
- Division of Child and Adolescent Health, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Rattananukrom
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Address correspondence to: Teerapong Rattananukrom, MD, MSc, Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand,
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Huang C, Gold S, Radi R, Amos S, Yeung H. Managing Dermatologic Effects of Gender-Affirming Therapy in Transgender Adolescents. Adolesc Health Med Ther 2022; 13:93-106. [PMID: 36237602 PMCID: PMC9552673 DOI: 10.2147/ahmt.s344078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
Transgender adolescents seek gender-affirming medical care to address gender identity and incongruence. Improved understanding of the dermatologic impact of gender-affirming medical care such as pubertal suppression, hormone therapy, and surgeries can enhance patient outcome. Pubertal suppression treats dysphoria associated with development of secondary sex characteristics, including androgen-driven acne. Gender-affirming hormone therapy influences acne and hair development in transgender adolescents. Dermatologists can help manage skin effects associated with chest binding and gender-affirming hormone therapy and surgery. Provision of patient-centered gender-affirming care in dermatologic and multidisciplinary settings is essential to improve skin and overall outcomes of gender-affirming therapy.
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Affiliation(s)
- Christina Huang
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Gold
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rakan Radi
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth Amos
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA,Clinical Resource Hub, Veterans Affairs Southeast Network Veterans Integrated Service Network 7, Decatur, GA, USA,Correspondence: Howa Yeung, Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE Suite 100, Atlanta, GA, 30322, USA, Tel +1 (404) 727-9838, Fax +1 (404) 727-5878, Email
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7
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Swink SM, Castelo-Soccio L. Dermatologic considerations for transgender and gender diverse youth. Pediatr Dermatol 2021; 38 Suppl 2:58-64. [PMID: 34250638 DOI: 10.1111/pde.14685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sexual and gender minority individuals, including transgender and gender diverse people, are an underserved and vulnerable population in the field of dermatology. While the unique dermatologic needs for adult patients in this group are increasingly documented, the knowledge surrounding pediatric and adolescent transgender/gender diverse patients is lacking. We aim to summarize the unique dermatologic needs of transgender/gender diverse patients, with particular attention paid to the data available in younger groups. This review highlights the unique role pediatric dermatologists can play in the care of transgender and gender diverse youth including but not limited to treating acne and hair pattern changes as well as being knowledgeable about surgical and other cosmetic options for gender affirmation. It also highlights areas for potential future research including dermatologic effects of hormone therapy in children as well as treatments for those side effects.
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Affiliation(s)
- Shane M Swink
- Division of Dermatology, Lehigh Valley Health Network, Allentown, PA, USA
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8
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Thoreson N, Grasso C, Potter J, King DS, Peebles JK, Dommasch ED. Incidence and Factors Associated With Androgenetic Alopecia Among Transgender and Gender-Diverse Patients Treated With Masculinizing Hormone Therapy. JAMA Dermatol 2021; 157:348-349. [PMID: 33566078 DOI: 10.1001/jamadermatol.2020.5475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nick Thoreson
- Boston University School of Medicine, Boston, Massachusetts.,The Fenway Institute, Fenway Health, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Department of Dermatology, Boston, Massachusetts
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Dana S King
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - J Klint Peebles
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Department of Dermatology, Rockville, Maryland
| | - Erica D Dommasch
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Department of Dermatology, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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9
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Patel V, Nolan IT, Card E, Morrison SD, Bared A. Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice. Aesthet Surg J 2021; 41:NP42-NP51. [PMID: 33565575 DOI: 10.1093/asj/sjaa430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients. OBJECTIVES This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients. METHODS A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction. RESULTS We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations. CONCLUSIONS Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Viren Patel
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Elizabeth Card
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
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A Randomized Double-Blind Placebo-Controlled Pilot Trial on the Effects of Testosterone Undecanoate Plus Dutasteride or Placebo on Muscle Strength, Body Composition, and Metabolic Profile in Transmen. J Sex Med 2021; 18:646-655. [PMID: 33531255 DOI: 10.1016/j.jsxm.2020.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/20/2020] [Accepted: 12/27/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND While the effects of androgens on muscle are well described in hypogonadal men, literature is still scarce on muscular strength or size variations in transmen; in this population there are no data regarding the relative effect of testosterone (T) and its metabolite dihydrotestosterone on muscle. AIM Our primary objective was to compare the effects on muscle strength of 54-week administration of testosterone undecanoate (TU) combined with the 5α-reductase inhibitor dutasteride (DT) or placebo (PL). Secondary outcomes included evaluation of body composition, bone, cutaneous androgenic effects, and metabolic variations. METHODS In this randomized, double-blind PL-controlled pilot trial, 16 ovariectomized transmen were randomized to receive TU 1,000 mg IM at week 0, 6, 18, 30, 42 plus a PL pill orally daily (TU + PL, n = 7) or plus DT 5 mg/d (TU + DT, n = 7). OUTCOMES At week 0 and 54 the following parameters were evaluated: isokinetic knee extension and flexion peak torque and handgrip strength, body composition, and bone mineral density, biochemical, hematological, and hormonal parameters. RESULTS Handgrip and lower limb strength increased significantly in both groups with no differences between the 2 groups. Fat mass decreased and lean mass increased significantly similarly in both groups. Metabolic parameters remained stable in the 2 groups except for high-density lipoprotein cholesterol that was reduced in both groups. Hepatic and renal function remained normal in both groups and no major adverse effects were registered in either group. CLINICAL IMPLICATIONS These results may be particularly relevant for transmen experiencing cutaneous androgenic adverse events such as acne and androgenetic alopecia and in light of the development of non-5α-reduced androgens. STRENGTHS & LIMITATIONS The strength of this study was the randomized, double-blind PL-controlled design, while the small number of subjects was definitely the biggest limitation. CONCLUSION For the first time we demonstrated that the addition of DT does not impair the anabolic effects of T on muscles in transmen previously exposed to T, supporting the hypothesis that the conversion in dihydrotestosterone is not essential for this role. Gava G, Armillotta F, Pillastrini P, et al. A Randomized Double-Blind Placebo-Controlled Pilot Trial on the Effects of Testosterone Undecanoate Plus Dutasteride or Placebo on Muscle Strength, Body Composition, and Metabolic Profile in Transmen. J Sex Med 2021;18:646-655.
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Cocchetti C, Ristori J, Romani A, Maggi M, Fisher AD. Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals. J Clin Med 2020; 9:jcm9061609. [PMID: 32466485 PMCID: PMC7356977 DOI: 10.3390/jcm9061609] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: To date no standardized hormonal treatment protocols for non-binary transgender individuals have been described in the literature and there is a lack of data regarding their efficacy and safety. Objectives: To suggest possible treatment strategies for non-binary transgender individuals with non-standardized requests and to emphasize the importance of a personalized clinical approach. Methods: A narrative review of pertinent literature on gender-affirming hormonal treatment in transgender persons was performed using PubMed. Results: New hormonal treatment regimens outside those reported in current guidelines should be considered for non-binary transgender individuals, in order to improve psychological well-being and quality of life. In the present review we suggested the use of hormonal and non-hormonal compounds, which—based on their mechanism of action—could be used in these cases depending on clients’ requests. Conclusion: Requests for an individualized hormonal treatment in non-binary transgender individuals represent a future challenge for professionals managing transgender health care. For each case, clinicians should balance the benefits and risks of a personalized non-standardized treatment, actively involving the person in decisions regarding hormonal treatment.
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Affiliation(s)
- Carlotta Cocchetti
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Florence University Hospital, 50139 Florence, Italy; (C.C); (J.R.); (A.R.)
| | - Jiska Ristori
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Florence University Hospital, 50139 Florence, Italy; (C.C); (J.R.); (A.R.)
| | - Alessia Romani
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Florence University Hospital, 50139 Florence, Italy; (C.C); (J.R.); (A.R.)
| | - Mario Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, 50139 Florence, Italy;
| | - Alessandra Daphne Fisher
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Florence University Hospital, 50139 Florence, Italy; (C.C); (J.R.); (A.R.)
- Correspondence:
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