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Hamilton B, Guppy F, Pitsiladis Y. Comment on: "Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage". Sports Med 2024; 54:237-242. [PMID: 37726582 DOI: 10.1007/s40279-023-01928-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Blair Hamilton
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
- Centre for Stress and Age-Related Disease, University of Brighton, Eastbourne, UK
- The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, UK
| | - Fergus Guppy
- Institute of Life and Earth Sciences, Heriot-Watt University, Edinburgh, UK
| | - Yannis Pitsiladis
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong.
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2
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Dijkman BAM, Helder D, Boogers LS, Gieles NC, van Heesewijk JO, Slaa ST, Liberton NPTJ, Wiepjes CM, de Blok CJM, den Heijer M, Dreijerink KMA. Addition of progesterone to feminizing gender-affirming hormone therapy in transgender individuals for breast development: a randomized controlled trial. BMC Pharmacol Toxicol 2023; 24:80. [PMID: 38124194 PMCID: PMC10734173 DOI: 10.1186/s40360-023-00724-4] [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: 03/15/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Feminizing gender-affirming hormone therapy (GAHT) for transgender individuals traditionally includes estradiol and androgen deprivation. Research has demonstrated that breast size as a result of GAHT in transgender women is often limited. Therefore, transgender women often choose to undergo breast augmentation surgery. Progesterone is important for breast development in cisgender women during puberty. A potential role for progesterone in breast development in transgender women has not been investigated in a randomized controlled experimental set-up. The primary objective of this study is to explore the effects on breast volume of addition of oral progesterone to GAHT with estradiol in transgender women after vaginoplasty or orchiectomy. Secondary objectives include assessment of safety, satisfaction, mood, sleep and sexual pleasure. METHODS This is a non-blinded, non-placebo, randomized controlled trial using a factorial design in adult transgender individuals assigned male sex at birth who have undergone GAHT for at least one year and underwent vaginoplasty or orchiectomy. The study design allows for rapid assessment of potential synergistic effects of various dose combinations of estradiol and progesterone on breast volume change: Ninety participants will be randomized into six groups of 15 subjects each, receiving either the baseline dose of estradiol, the baseline dose of estradiol and progesterone 200 mg daily, the baseline dose of estradiol and progesterone 400 mg daily, twice the baseline dose of estradiol, twice the baseline dose of estradiol and progesterone 200 mg daily or twice the baseline dose of estradiol and progesterone 400 mg daily, all for a duration of 12 months. The main study parameters include changes in breast volume as determined by 3D measurements. Participants will be followed-up with laboratory testing including serum progesterone concentrations as well as surveys for satisfaction, mood, sleep quality and sexual pleasure. DISCUSSION This study will indicate whether progesterone is safe and of additional value with regard to breast volume change in transgender individuals receiving feminizing GAHT. The results of this study will be useful for innovation of feminizing GAHT. TRIAL REGISTRATION WHO International Clinical Trials Registry Platform: EUCTR2020-001952-16-NL; date of registration: 12 December 2020 https://trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2020-001952-16-NL .
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Affiliation(s)
- Benthe A M Dijkman
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Endo-ERN Reference Center; Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Danithsia Helder
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Endo-ERN Reference Center; Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Lidewij S Boogers
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Endo-ERN Reference Center; Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Noor C Gieles
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Endo-ERN Reference Center; Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jason O van Heesewijk
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Endo-ERN Reference Center; Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Sjoerd Te Slaa
- Department of Medical Technology, 3D Innovation Lab, Amsterdam UMC, location VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Niels P T J Liberton
- Department of Medical Technology, 3D Innovation Lab, Amsterdam UMC, location VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Chantal M Wiepjes
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Endo-ERN Reference Center; Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Christel J M de Blok
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Endo-ERN Reference Center; Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Endo-ERN Reference Center; Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Koen M A Dreijerink
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Endo-ERN Reference Center; Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Research Institute Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, location VU University, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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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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More Data Against the Addition of Progestogens to Gender-Affirming Hormone Therapy Regimens. Endocr Pract 2022; 28:1274-1275. [PMID: 36347466 DOI: 10.1016/j.eprac.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
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Patel KT, Adeel S, Rodrigues Miragaya J, Tangpricha V. Progestogen Use in Gender-Affirming Hormone Therapy: A Systematic Review. Endocr Pract 2022; 28:1244-1252. [PMID: 36007714 DOI: 10.1016/j.eprac.2022.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Transgender women take gender-affirming hormone therapy (GAHT) to affirm their gender identity and improve quality of life and well-being. Usually, GAHT in transgender women consists of estrogen plus a testosterone-lowering medication. The use of progestogens in GAHT for transgender women has been a controversial topic due to lack of evidence for benefit and potential for increased harm. METHODS A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 4 databases (PubMed/MEDLINE, Ovid, and Cochrane). Manuscripts were reviewed from January 2000 to March 2022 to identify effects of progestogens in transgender women over the age of 16 years on breast development, cardiovascular disease, bone density, quality of life, and stroke incidence. RESULTS Ten articles were deemed eligible based on specific inclusion and exclusion criteria. Studies analyzing users of cyproterone acetate were also included if there was a comparator group. No relevant studies were found assessing stroke incidence in the transgender population using a progestogen compound. CONCLUSION Overall, findings were significant for a decreased high-density lipoprotein level and increased thromboembolism risk in transgender women using progestogens. No conclusive evidence was found regarding improved quality of life or breast development. Further research needs to be conducted assessing the effects of progestogens in transgender women.
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Affiliation(s)
| | - Saira Adeel
- Wellstar Kennestone Regional Medical Center, Marietta, Georgia
| | | | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta VA Medical Center, Decatur, Georgia.
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6
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Gusmão-Silva JV, Lichtenecker DCK, Ferreira LGA, Gois Í, Argeri R, Gomes GN, Dias-da-Silva MR. Body, metabolic and renal changes following cross-sex estrogen/progestogen therapy in a rodent model simulating its use by transwomen. J Endocrinol Invest 2022; 45:1875-1885. [PMID: 35689728 DOI: 10.1007/s40618-022-01817-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The use of sex steroids by trans people has been of paramount importance regarding body changes during gender transition. The objective of this study was to assess the effects of an injectable steroid combination frequently used by transwomen, namely estradiol enanthate with dihydroxyprogesterone acetophenide (E2EN/DHPA), on blood pressure and metabolic outcomes using an animal model. METHODS Two-month-old male Wistar rats were orchiectomized or sham-operated and divided into groups: (1) Sham treated with sesame oil vehicle (SG), (2) sham treated with E2EN/DHPA (SP), (3) orchiectomized rats treated with vehicle (OG), and (4) orchiectomized rats treated with E2EN/DHPA (OP), with all groups treated every 10 days for 5 months. We evaluated systolic blood pressure (SBP), body weight (BW), abdominal circumference, nasoanal length (NAL), food and water intake (FI, WI), lipid profile (triglycerides, LDL, and HDL), serum C-reactive protein (CRP), plasma concentrations of urea (URpl) and creatinine (CRpl), 24 h urinary volume (V24 h), sodium and potassium excretion (UNa+, UK+), and proteinuria. RESULTS E2EN/DHPA administration reduced BW (SP 324.5 ± 31.1; OP 291.7 ± 41.3 g) and NAL (SP 24.5 ± 0.4; OP 24.6 ± 1.0 cm), without changing blood pressure, but increased URpl concentration (SP 55.0 ± 4.8; OP 42.5 ± 8.8 mg/dL) and CRpl (SP 0.47 ± 0.05; OP 0.46 ± 0.04 mg/dL), sodium (SP 3.1 ± 0.8; OP 3.3 ± 0.4 µEq/min/kg), potassium (SP 0.91 ± 0.22; OP 0.94 ± 0.22 µEq/min/kg) excretions and urinary volume (SP 15.5 ± 2.1; OP 16.4 ± 2.9 mL/24 h). CONCLUSION Cross-sex hormone therapy with E2EN/DHPA significantly modified body characteristics in male rats, producing a feminizing change without altering blood pressure or generating harmful metabolic parameters, but larger translational studies are still needed.
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Affiliation(s)
- J V Gusmão-Silva
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil
| | - D C K Lichtenecker
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil
| | - L G A Ferreira
- Laboratory of Molecular and Translational Endocrinology (LEMT), Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Pedro de Toledo, nº 699, Sao Paulo, 04039-032, Brazil
| | - Í Gois
- Laboratory of Molecular and Translational Endocrinology (LEMT), Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Pedro de Toledo, nº 699, Sao Paulo, 04039-032, Brazil
- Trans Care Outpatient Clinics; Núcleo de Estudos, Pesquisa, Extensão e Assitência à Pessoa Trans Professor Roberto Farina, Universidade Federal de Sao Paulo (Núcleo TransUnifesp), Rua Napoleão de Barros nº 859, Sao Paulo, 04024-002, Brazil
| | - R Argeri
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil
| | - G N Gomes
- Laboratory of Renal Physiology, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Botucatu nº 862, Sao Paulo, 04023-900, Brazil.
| | - M R Dias-da-Silva
- Laboratory of Molecular and Translational Endocrinology (LEMT), Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM/Unifesp), Rua Pedro de Toledo, nº 699, Sao Paulo, 04039-032, Brazil
- Trans Care Outpatient Clinics; Núcleo de Estudos, Pesquisa, Extensão e Assitência à Pessoa Trans Professor Roberto Farina, Universidade Federal de Sao Paulo (Núcleo TransUnifesp), Rua Napoleão de Barros nº 859, Sao Paulo, 04024-002, Brazil
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Krupka E, Curtis S, Ferguson T, Whitlock R, Askin N, Millar AC, Dahl M, Fung R, Ahmed SB, Tangri N, Walsh M, Collister D. The Effect of Gender-Affirming Hormone Therapy on Measures of Kidney Function: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2022; 17:1305-1315. [PMID: 35973728 PMCID: PMC9625103 DOI: 10.2215/cjn.01890222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/27/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Gender-affirming hormone therapy modifies body composition and lean muscle mass in transgender persons. We sought to characterize the change in serum creatinine, other kidney function biomarkers, and GFR in transgender persons initiating masculinizing and feminizing gender-affirming hormone therapy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov from inception to September 16, 2020 for randomized controlled trials, observational studies, and case series that evaluated the change in serum creatinine, other kidney function biomarkers, and GFR before and after the initiation of gender-affirming hormone therapy in adult transgender persons. Two reviewers independently screened and abstracted data, and disagreements were resolved by a third reviewer. A random effects meta-analysis was performed to determine the change in outcomes over follow-up of 3, 6, and 12 months. RESULTS Of the 4758 eligible studies, 26 met the inclusion criteria, including nine studies that recruited 488 transgender men and 593 women in which data were meta-analyzed. There was heterogeneity in study design, populations, gender-affirming hormone therapy routes, and dosing. At 12 months after initiating gender-affirming hormone therapy, serum creatinine increased by 0.15 mg/dl (95% confidence interval, 0.00 to 0.29) in 370 transgender men and decreased by -0.05 mg/dl (95% confidence interval, -0.16 to 0.05) in 361 transgender women. No study reported the effect of gender-affirming hormone therapy on albuminuria, proteinuria, cystatin C, or measured GFR. CONCLUSIONS Gender-affirming hormone therapy increases serum creatinine in transgender men and does not affect serum creatinine in transgender women. The effect on gender-affirming hormone therapy on other kidney function biomarkers and measured GFR is unknown. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Change in Kidney Function Biomarkers in Transgender Persons on Gender Affirmation Hormone Therapy-A Systematic Review and Meta-Analysis, CRD42020214248.
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Affiliation(s)
- Emily Krupka
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Sarah Curtis
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Thomas Ferguson
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Reid Whitlock
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam C. Millar
- Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marshall Dahl
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond Fung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Michael Garron Hospital, Toronto, Ontario, Canada
| | - Sofia B. Ahmed
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Max Rady Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Walsh
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada
| | - David Collister
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Max Rady Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada
- Section of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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8
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Majumder A. Endocrine Therapy of Adult Gender-Incongruent Individuals Seeking Gender Reaffirmation. Indian J Plast Surg 2022; 55:149-155. [PMID: 36017400 PMCID: PMC9398529 DOI: 10.1055/s-0042-1749406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
AbstractGender-affirming hormone therapy (GAHT) is integral to the management of gender-incongruent (GI) individuals. GAHT greatly improves the quality of life for GI individuals. Current research about outcomes of GAHT and adverse events in adults receiving GAHT is limited in India and large cohort studies are absent. This document on medical management provides protocols for the prescribing clinician relating to counseling for GAHT, baseline evaluation, choice of therapy, targets for hormone therapy, clinical and biochemical monitoring, and perioperative hormone therapy.
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Affiliation(s)
- Anirban Majumder
- Department of Endocrinology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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9
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Nolan BJ, Frydman AS, Leemaqz SY, Carroll M, Grossmann M, Zajac JD, Cheung AS. Effects of low-dose oral micronised progesterone on sleep, psychological distress, and breast development in transgender individuals undergoing feminising hormone therapy: a prospective controlled study. Endocr Connect 2022; 11:e220170. [PMID: 35521814 PMCID: PMC9175584 DOI: 10.1530/ec-22-0170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
Objective The role of micronised progesterone in hormone regimens for transgender individuals undergoing feminising hormone therapy remains uncertain. We aimed to determine the effect of oral micronised progesterone on sleep quality, psychological distress, and breast development in transgender individuals undergoing feminising hormone therapy. Design Prospective case-control study. Twenty-three transgender individuals on stable oestradiol treatment newly commencing 100 mg oral progesterone (n = 23) and controls continuing standard care (n = 19) were assessed over 3 months. Methods Pittsburgh Sleep Quality Index (PSQI), Kessler psychological distress scale (K10), and Tanner stage to assess breast development were assessed at 0 and 3 months. Non-parametric analysis of covariance was used to compare differences between groups. Results Compared with controls over 3 months, there was no difference in PSQI (P = 0.35), K10 (P = 0.64), or Tanner stage (P = 0.42). There was no significant difference in the proportion of individuals with clinically significant improvement in PSQI (25% vs 22%, P = 0.84). One individual had a significant deterioration in psychological distress that improved following the cessation of progesterone. Conclusions Low-dose progesterone was not associated with changes in sleep quality, psychological distress, or breast development over 3 months follow-up, though there was significant inter-individual variability. Larger, placebo-controlled trials are required to further evaluate different doses of progesterone in feminising hormone therapy regimens.
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Affiliation(s)
- Brendan J Nolan
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
| | - Aviva S Frydman
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Shalem Y Leemaqz
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Meg Carroll
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
| | - Jeffrey D Zajac
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
| | - Ada S Cheung
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
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10
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Fisher AD, Senofonte G, Cocchetti C, Guercio G, Lingiardi V, Meriggiola MC, Mosconi M, Motta G, Ristori J, Speranza AM, Pierdominici M, Maggi M, Corona G, Lombardo F. SIGIS-SIAMS-SIE position statement of gender affirming hormonal treatment in transgender and non-binary people. J Endocrinol Invest 2022; 45:657-673. [PMID: 34677807 DOI: 10.1007/s40618-021-01694-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/10/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE Gender Incongruence (GI) is a marked and persistent incongruence between an individual's experienced and the assigned gender at birth. In the recent years, there has been a considerable evolution and change in attitude as regards to gender nonconforming people. METHODS According to the Italian Society of Gender, Identity and Health (SIGIS), the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE) rules, a team of experts on the topic has been nominated by a SIGIS-SIAMS-SIE Guideline Board on the basis of their recognized clinical and research expertise in the field, and coordinated by a senior author, has prepared this Position statement. Later on, the present manuscript has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing after a first internal revision process made by the SIGIS-SIAMS-SIE Guideline Board. RESULTS In the present document by the SIGIS-SIAMS-SIE group, we propose experts opinions concerning the psychological functioning, gender affirming hormonal treatment, safety concerns, emerging issues in transgender healthcare (sexual health, fertility issues, elderly trans people), and an Italian law overview aimed to improve gender non-conforming people care. CONCLUSION In this Position statement, we propose experts opinions concerning the psychological functioning of transgender people, the gender-affirming hormonal treatment (full/partial masculinization in assigned female at birth trans people, full/partial feminization and de-masculinization in assigned male at birth trans people), the emerging issues in transgender health care aimed to improve patient care. We have also included an overview of Italian law about gender affirming surgery and registry rectification.
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Affiliation(s)
- A D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Senofonte
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, 00185, Rome, Italy
| | - C Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Guercio
- Studio Legale Avv. Giovanni Guercio, Via Antonio Mordini, 14, 00195, Rome, Italy
| | - V Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185, Roma, Italy
| | - M C Meriggiola
- Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - M Mosconi
- Gender Identity Development Service, Hospital S. Camillo-Forlanini, Rome, Italy
| | - G Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - J Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - A M Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185, Roma, Italy
| | - M Pierdominici
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl, Bologna, Italy
| | - F Lombardo
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, 00185, Rome, Italy.
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11
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Motosko CC, Tosti A. Dermatologic Care of Hair in Transgender Patients: A Systematic Review of Literature. Dermatol Ther (Heidelb) 2021; 11:1457-1468. [PMID: 34235628 PMCID: PMC8484383 DOI: 10.1007/s13555-021-00574-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/25/2021] [Indexed: 10/26/2022] Open
Abstract
Transgender patients on masculinizing and feminizing hormonal therapy undergo myriad physical and psychologic changes. Dermatologists are uniquely qualified to guide patients in the gender-affirming process, especially as it relates to hair. Given the paucity of literature guiding dermatologists in this process, a systematic review was performed to better understand the physiologic changes of hair in patients on masculinizing and feminizing hormonal therapy as well as the variety of treatment options that exist to help transgender patients to attain their desired hair growth pattern. This review reports findings and treatment options supported by the performed literature review as well as treatment recommendations based on the authors' own experiences treating this unique patient population.
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Affiliation(s)
- Catherine C Motosko
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA.
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12
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Roberts SA, Carswell JM. Growth, growth potential, and influences on adult height in the transgender and gender-diverse population. Andrology 2021; 9:1679-1688. [PMID: 33969625 PMCID: PMC9135059 DOI: 10.1111/andr.13034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 12/30/2022]
Abstract
The sexually dimorphic trait of height is one aspect of the experience of transgender and gender‐diverse (TGD) individuals that may influence their gender dysphoria and satisfaction with their transition. In this article, we have reviewed the current knowledge of the factors that contribute to one's final adult height and how it might be affected in TGD youth who have not experienced their gonadal puberty in the setting of receiving gonadotropin‐releasing hormone analog (GnRHa) and gender‐affirming hormonal treatment. Additional research is needed to characterize the influence of growth and final adult height on the lived experience of TGD youth and adults and how to best assess their growth, predict their final adult height, and how medical transition can be potentially modified to help them meet their goals.
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Affiliation(s)
- Stephanie A Roberts
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jeremi M Carswell
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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13
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Angus LM, Nolan BJ, Zajac JD, Cheung AS. A systematic review of antiandrogens and feminization in transgender women. Clin Endocrinol (Oxf) 2021; 94:743-752. [PMID: 32926454 DOI: 10.1111/cen.14329] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 01/01/2023]
Abstract
Antiandrogens are frequently used with estradiol in transgender women seeking feminization. Antiandrogens act by various mechanisms to decrease the production or effects of testosterone, but it is unclear which antiandrogen is most effective at feminization. A systematic review was performed using PRISMA guidelines. We searched online databases (Medline, Embase and PsycINFO) and references of relevant articles for studies of antiandrogens in transgender women aged 16+ years to achieve feminization (namely changes in breast size, body composition, facial or body hair) or changes in serum total testosterone concentration when compared to placebo, estradiol alone or an alternative antiandrogen. Four studies fulfilled eligibility criteria and were included in a narrative review. The addition of cyproterone acetate, leuprolide and medroxyprogesterone acetate may be more effective than spironolactone or estradiol alone at suppressing the serum total testosterone concentration. Body composition changes appear similar in transgender women treated with estradiol and additional cyproterone acetate or leuprolide. No eligible studies adequately evaluated the effects of antiandrogens on breast development or facial and body hair reduction. It remains unclear which antiandrogen is most effective at achieving feminization. Cyproterone acetate, medroxyprogesterone acetate and leuprolide may be more effective than spironolactone at suppressing the serum total testosterone concentration. However, due to spironolactone's antagonism of the androgen receptor, it is unclear whether this results in clinically meaningful differences in feminization. Further research with clinically meaningful endpoints is needed to optimize the use of antiandrogens in transgender women.
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Affiliation(s)
- Lachlan M Angus
- Department of Medicine, The University of Melbourne, Heidelberg, Vic., Australia
- Department of Endocrinology, Austin Health, Ivanhoe, Vic., Australia
| | - Brendan J Nolan
- Department of Medicine, The University of Melbourne, Heidelberg, Vic., Australia
- Department of Endocrinology, Austin Health, Ivanhoe, Vic., Australia
| | - Jeffrey D Zajac
- Department of Medicine, The University of Melbourne, Heidelberg, Vic., Australia
- Department of Endocrinology, Austin Health, Ivanhoe, Vic., Australia
| | - Ada S Cheung
- Department of Medicine, The University of Melbourne, Heidelberg, Vic., Australia
- Department of Endocrinology, Austin Health, Ivanhoe, Vic., Australia
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14
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Harper J, O'Donnell E, Sorouri Khorashad B, McDermott H, Witcomb GL. How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation. Br J Sports Med 2021; 55:865-872. [PMID: 33648944 PMCID: PMC8311086 DOI: 10.1136/bjsports-2020-103106] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
Objectives We systemically reviewed the literature to assess how long-term testosterone suppressing gender-affirming hormone therapy influenced lean body mass (LBM), muscular area, muscular strength and haemoglobin (Hgb)/haematocrit (HCT). Design Systematic review. Data sources Four databases (BioMed Central, PubMed, Scopus and Web of Science) were searched in April 2020 for papers from 1999 to 2020. Eligibility criteria for selecting studies Eligible studies were those that measured at least one of the variables of interest, included transwomen and were written in English. Results Twenty-four studies were identified and reviewed. Transwomen experienced significant decreases in all parameters measured, with different time courses noted. After 4 months of hormone therapy, transwomen have Hgb/HCT levels equivalent to those of cisgender women. After 12 months of hormone therapy, significant decreases in measures of strength, LBM and muscle area are observed. The effects of longer duration therapy (36 months) in eliciting further decrements in these measures are unclear due to paucity of data. Notwithstanding, values for strength, LBM and muscle area in transwomen remain above those of cisgender women, even after 36 months of hormone therapy. Conclusion In transwomen, hormone therapy rapidly reduces Hgb to levels seen in cisgender women. In contrast, hormone therapy decreases strength, LBM and muscle area, yet values remain above that observed in cisgender women, even after 36 months. These findings suggest that strength may be well preserved in transwomen during the first 3 years of hormone therapy.
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Affiliation(s)
- Joanna Harper
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma O'Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Hilary McDermott
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Gemma L Witcomb
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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15
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Totaro M, Palazzi S, Castellini C, Parisi A, D’Amato F, Tienforti D, Baroni MG, Francavilla S, Barbonetti A. Risk of Venous Thromboembolism in Transgender People Undergoing Hormone Feminizing Therapy: A Prevalence Meta-Analysis and Meta-Regression Study. Front Endocrinol (Lausanne) 2021; 12:741866. [PMID: 34880832 PMCID: PMC8647165 DOI: 10.3389/fendo.2021.741866] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/20/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although venous thromboembolism (VTE) is a recognized side effect of some formulations of estrogen therapy, its impact in transgender people remains uncertain. The aim of this study was to define pooled prevalence estimate and correlates of VTE in Assigned Males at Birth (AMAB) trans people undergoing gender affirming hormone therapy. METHODS A thorough search of MEDLINE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases was carried out to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effects models and the between-study heterogeneity was assessed by the Cochrane's Q and I2. RESULTS The eighteen studies included gave information about 11,542 AMAB undergoing gender affirming hormone therapy. The pooled prevalence of VTE was 2% (95%CI:1-3%), with a large heterogeneity (I2 = 89.18%, P<0.0001). Trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimate. At the meta-regression analysis, a higher prevalence of VTE was significantly associated with an older age (S=0.0063; 95%CI:0.0022,0.0104, P=0.0027) and a longer length of estrogen therapy (S=0.0011; 95%CI:0.0006,0.0016, P<0.0001). When, according to the meta-regression results, the analysis was restricted to series with a mean age ≥37.5 years, the prevalence estimate for VTE increased up to 3% (95%CI:0-5%), but with persistence of a large heterogeneity (I2 = 88,2%, P<0.0001); studies on younger participants (<37.5 years) collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-2%) with no heterogeneity (I2 = 0%, P=0.97). Prevalence estimate for VTE in series with a mean length of estrogen therapy ≥53 months was 1% (95%CI:0-3%), with persistent significant heterogeneity (I2 = 84,8%, P=0.0006); studies on participants subjected to a shorter length of estrogen therapy (<53 months), collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-3%) with no heterogeneity (I2 = 0%, P=0.76). CONCLUSIONS The overall rate of VTE in AMAB trans people undergoing gender affirming hormone therapy was 2%. In AMAB population with <37.5 years undergoing estrogen therapy for less than 53 months, the risk of VTE appears to be negligible. Further studies are warranted to assess whether different types and administration routes of estrogen therapy could decrease the VTE risk in AMAB trans people over 37.5 years subjected to long-term therapy. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021229916].
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Affiliation(s)
- Maria Totaro
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Sara Palazzi
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Chiara Castellini
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Antonio Parisi
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Federica D’Amato
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Daniele Tienforti
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Marco Giorgio Baroni
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Sandro Francavilla
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- *Correspondence: Arcangelo Barbonetti,
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16
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Fortin CN, Moravek MB. Medical transition for gender diverse patients. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020; 9:166-177. [PMID: 36714061 PMCID: PMC9881054 DOI: 10.1007/s13669-020-00297-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose of review The purpose of this review is to provide an up-to-date overview of gender-affirming hormone therapy, including the various hormone regimens available, the efficacy and potential risks of these treatments, and considerations for surveillance and long-term care. Recent findings Recent studies reaffirm that hormone therapy has positive physical and psychological effects for many transgender individuals. The overall risks of treatment are low. Transgender women may have an increased risk of venous thromboembolism and breast cancer based on recent cohort studies, but these findings have yet to be confirmed with randomized controlled trials. Important long-term considerations include metabolic, cardiovascular, and skeletal health. Summary High-quality, long-term studies on the effectiveness and safety of various gender-affirming hormone treatment regimens are lacking, but the currently available evidence suggests that it is overall safe and effective with appropriate oversight.
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Affiliation(s)
| | - Molly B. Moravek
- Corresponding author: L4001 Women’s Hospital, 1500 E Medical Center Dr, Ann Arbor, MI,
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17
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Wilson LM, Baker KE, Sharma R, Dukhanin V, McArthur K, Robinson KA. Effects of antiandrogens on prolactin levels among transgender women on estrogen therapy: A systematic review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:391-402. [PMID: 34993517 PMCID: PMC8726721 DOI: 10.1080/15532739.2020.1819505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Gender-affirming hormone therapy for transgender women includes estrogen and antiandrogens (cyproterone acetate, spironolactone, or gonadotropin-releasing hormone agonists). Both estrogen and antiandrogens are reported to increase prolactin levels. The objective is to systematically review the evidence of the effects of antiandrogens on prolactin levels, hyperprolactinemia, and prolactinomas among transgender women on estrogen therapy. METHODS We searched PubMed, Embase, and PsycInfo up to May 2020. We included studies with at least 3 months follow-up that evaluated the effects of antiandrogens among transgender women and reported on prolactin levels, hyperprolactinemia, or image-confirmed prolactinomas. Two reviewers independently screened studies for eligibility, serially abstracted data, and independently assessed risk of bias and graded strength of evidence. FINDINGS We included 17 studies (16 publications): 8 prospective cohorts, 8 retrospective cohorts, and 1 cross-sectional study, each with a moderate to serious risk of bias. Among transgender women on estrogen, prolactin levels increased by over 100% with cyproterone acetate and by up to 45% with spironolactone. However, we were unable to isolate the effects of antiandrogens from estrogen therapy. We were unable to draw conclusions about effects of antiandrogens on hyperprolactinemia and prolactinomas. INTERPRETATION Prolactin levels may be increased in transgender women who are taking both estrogens and an antiandrogen. Future research is needed to determine the effects of different antiandrogens on prolactin levels separately from estrogen therapy. Ideally, future studies would be prospective, provide either a comparison of two different antiandrogens or compare combination of estrogen and antiandrogen therapy to estrogen alone, and control for possible confounders.
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Affiliation(s)
- Lisa M. Wilson
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- CONTACT Lisa M. Wilson Department of Health Policy and Management, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Kellan E. Baker
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristen McArthur
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen A. Robinson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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