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Wiik A, Andersson DP, Brismar TB, Chanpen S, Dhejne C, Ekström TJ, Flanagan JN, Holmberg M, Kere J, Lilja M, Lindholm ME, Lundberg TR, Maret E, Melin M, Olsson SM, Rullman E, Wåhlén K, Arver S, Gustafsson T. Metabolic and functional changes in transgender individuals following cross-sex hormone treatment: Design and methods of the GEnder Dysphoria Treatment in Sweden (GETS) study. Contemp Clin Trials Commun 2018; 10:148-153. [PMID: 30023449 PMCID: PMC6046513 DOI: 10.1016/j.conctc.2018.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 11/16/2022] Open
Abstract
Background Although the divergent male and female differentiation depends on key genes, many biological differences seen in men and women are driven by relative differences in estrogen and testosterone levels. Gender dysphoria denotes the distress that gender incongruence with the assigned sex at birth may cause. Gender-affirming treatment includes medical intervention such as inhibition of endogenous sex hormones and subsequent replacement with cross-sex hormones. The aim of this study is to investigate consequences of an altered sex hormone profile on different tissues and metabolic risk factors. By studying subjects undergoing gender-affirming medical intervention with sex hormones, we have the unique opportunity to distinguish between genetic and hormonal effects. Methods The study is a single center observational cohort study conducted in Stockholm, Sweden. The subjects are examined at four time points; before initiation of treatment, after endogenous sex hormone inhibition, and three and eleven months following sex hormone treatment. Examinations include blood samples, skeletal muscle-, adipose- and skin tissue biopsies, arteriography, echocardiography, carotid Doppler examination, whole body MRI, CT of muscle and measurements of muscle strength. Results The primary outcome measure is transcriptomic and epigenomic changes in skeletal muscle. Secondary outcome measures include transcriptomic and epigenomic changes associated with metabolism in adipose and skin, muscle strength, fat cell size and ability to release fatty acids from adipose tissue, cardiovascular function, and body composition. Conclusions This study will provide novel information on the role of sex hormone treatment in skeletal muscle, adipose and skin, and its relation to cardiovascular and metabolic disease.
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Affiliation(s)
- Anna Wiik
- Department of Laboratory Medicine, Karolinska Institutet, Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel P. Andersson
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Corresponding author. Department of Medicine (H7) C2:94, Karolinska Institutet, 14186 Stockholm, Sweden.
| | - Torkel B. Brismar
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Setareh Chanpen
- ANOVA, Andrology, Sexual Medicine and Transgender Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Dhejne
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- ANOVA, Andrology, Sexual Medicine and Transgender Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas J. Ekström
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - John N. Flanagan
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Mats Holmberg
- ANOVA, Andrology, Sexual Medicine and Transgender Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Juha Kere
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lilja
- Department of Laboratory Medicine, Karolinska Institutet, Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Malene E. Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Tommy R. Lundberg
- Department of Laboratory Medicine, Karolinska Institutet, Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Maret
- Department of Laboratory Medicine, Karolinska Institutet, Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Melin
- Heart and Vascular Theme, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sofie M. Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Rullman
- Department of Laboratory Medicine, Karolinska Institutet, Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Wåhlén
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Stefan Arver
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Thomas Gustafsson
- Department of Laboratory Medicine, Karolinska Institutet, Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
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