Background: Transgender individuals often require gender-affirming interventions, such as endogenous sex hormone inhibition or gender-affirming hormone therapy (HT), while there is discordance between their body and gender identity. However, a recent study found that the incidence of cardiovascular events is higher in transgender patients receiving cross-sex HT. The aim of this study was to investigate the metabolic effects of an altered sex hormone profile. Methods: This retrospective study, conducted in a referral center in Northern Taiwan, analyzed metabolic changes over time in 65 trans masculine and 45 trans feminine persons. The transgender individuals were examined at 4 time points: before the gender affirming HT, as well as 3, 6, and 12 months following treatment. Results: Compared with baseline measurements, the trans masculine patients showed significant increases in body mass index (BMI) (22.6 ± 0.3 vs 23.3 ± 0.4 kg/m2; p < 0.001; t = 3M), low-density lipoprotein cholesterol (124.3 ± 3.7 vs 131.3 ± 3.9 mg/dL; p = 0.03; t = 12M), creatinine (0.75 ± 0.01 vs 0.83 ± 0.14 mg/dL; p < 0.001; t = 12M), and hemoglobin (13.5 ± 0.7 vs 15.2 ± 0.2 g/dL; p < 0.001; t = 12M), as well as decreased high-density lipoprotein cholesterol (57 ± 2.1 vs 51 ± 2.0 mg/dL; p < 0.001; t = 12M). The trans feminine patients had reduced low-density lipoprotein cholesterol (104.2 ± 3.2 vs 100.8 ± 3.5 mg/dL; p = 0.05; t = 3M), hemoglobin (14.0 ± 0.1 vs 13.5 ± 0.1 g/dL; p = 0.008; t = 12M), and creatinine (0.82 ± 0.01 vs 0.79 ± 0.14 mg/dL; p < 0.001; t = 3M) compared with baseline data. In addition, most of these metabolic effects persisted during the follow-up period. Conclusion: This observational, retrospective study revealed that gender-affirming HT increased the relative cardiovascular risk in trans masculine individuals.

Objective: Many biological differences seen in men and women are driven by relative different level of estrogen and testosterone. Transgender individuals may need gender-affirming intervention like inhibiting of endogenous sex hormones or replenishing cross-hormone to induce physical change to stimulate their expressed or experienced gender. However, recent study has concluded that the incidences of acute cardiovascular events are higher in transwomen receiving transgender hormone therapy (1). Transgender therapy for adults with Testosterone in female to male (FtM); with Estrogen and anti-androgen in male to female (MtF) are frequently prescribed in Taiwan. The aim of this study is to investigate metabolic effects of an altered sex hormone profile on different gender. Methods: The study is a retrospective study conducted in a tertiary medical center in Northern Taiwan analyzing biological differences over time for 65 FtM and 45 MtF patients in our endocrine out-patient department. The results from the exams are analyzed separately using paired t-test compared to baseline visit. The transgender individuals are examined at four time points; before the cross-hormone therapy, three, six, and twelve months following sex hormone treatment. Results: The primary outcome was that FtM patients showed significant increases in BMI (22.6±0.3 v.s. 23.3±0.4 kg/m2; P&lt;0.001; t=6M), low density lipoprotein cholesterol (124±3 vs.131±3 mg/dL; P=0.03; t=12M), creatinine (0.75±0.01 vs.0.83±0.14 mg/dL; P&lt;0.001; t=12M), and hemoglobin (13.5±0.7 v.s. 15.2±0.19 g/dL; P&lt;0.001; t=12M) compared to the baseline; decreases of high density lipoprotein cholesterol (57±2.1 v.s. 51±2.0 mg/dL; &lt;0.001; t=12M) was also revealed. Patients in MtF group disclosed declines in low density lipoprotein cholesterol (104±3 v.s. 100±3 mg/dL; P=0.05; t=3M), hemoglobin (14.0±0.1 v.s. 13.5±0.1 g/dL; P=0.008; t=12M), uric acid (5.3±0.2 v.s. 4.7±0.2mg/dL; P=0.03; t=12M) and creatinine (0.82±0.01 v.s. 0.79±0.14 mg/dL; P&lt;0.001; t=6M) compared to baseline data. In addition, most of these metabolic effects persisted the follow-up period. Conclusion: This observational study revealed the role of cross-hormone treatment in increasing relative cardiovascular risk in FtM transgender individuals. Reference: 1. Nota, N. M., et al. (2019). “Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy: Results From a Large Cohort Study.” Circulation 139(11): 1461-1462. Nothing to Disclose: LYL, YHL, THW, YCL