Alterations in Lipids and Adipocyte Hormones in Female-to-Male Transsexuals

Abstract

Testosterone therapy in men and women results in decreased high-density lipoprotein cholesterol (HDL) and increased low-density lipoprotein cholesterol (LDL). We sought to determine whether testosterone therapy has this same effect on lipid parameters and adipocyte hormones in female-to-male (FTM) transsexuals. Twelve FTM transsexuals provided a fasting lipid profile including serum total cholesterol, HDL, LDL, and triglycerides prior to and after 1 year of testosterone therapy (testosterone enanthate or cypionate 50–125 mg IM every two weeks). Subjects experienced a significant decrease in mean serum HDL (52 ± 11 to 40 ± 7 mg/dL) (P < .001). The mean LDL (P = .316), triglyceride (P = .910), and total cholesterol (P = .769) levels remained unchanged. In a subset of subjects, we measured serum leptin levels which were reduced by 25% but did not reach statistical significance (P = .181) while resistin levels remained unchanged. We conclude that testosterone therapy in FTM transsexuals can promote an increased atherogenic lipid profile by lowering HDL and possibly reduce serum leptin levels. However, long-term studies are needed to determine whether decreases in HDL result in adverse cardiovascular outcomes.

The Effects of Long-Term Testosterone Use on Lipid-Related Cardiovascular Risk Factors Among FtM Patients

“…Triglycerides (TG), total cholesterol, high-density lipoprotein (HDL), and lowdensity lipoprotein (LDL) were measured before and after testosterone therapy began in order to compare changes. Statistically significant decreases in mean HDL were observed in five of the seven studies that reported HDL levels (Chandra et al, 2010;Elamin et al, 2010;Gooren & Giltay, 2008;Ott et al, 2011;. Mean TG elevations were reported in four studies (Elamin et al, 2010;Ott et al, 2011;Gooren & Giltay, 2008); while Chandra et al found that TGs as well as total cholesterol and LDLs remained unchanged.…”

“…All of the articles referred to cohort studies that included FtM patients receiving long-term testosterone therapy (Asscheman et al, 2011;Chandra et al, 2010;Elamin et al, 2010;Gooren & Giltay, 2008;Ott, Aust, Promberger, Huber, & Kaufmann, 2011;Wierckx et al, 2012). Follow-up after testosterone therapy was maintained for at least 1 year later in seven of the eight articles reviewed (Asscheman et al, 2011;Chandra et al, 2010;Gooren & Giltay, 2008;Jacobeit, Gooren, & Schulte, 2009, Ott et al, 2011Wierckx et al, 2012).…”

“…Follow-up after testosterone therapy was maintained for at least 1 year later in seven of the eight articles reviewed (Asscheman et al, 2011;Chandra et al, 2010;Gooren & Giltay, 2008;Jacobeit, Gooren, & Schulte, 2009, Ott et al, 2011Wierckx et al, 2012). All but one of the reviewed articles (Asscheman et al, 2011) lipid profiles as markers for CV health.…”

“…The study by Chandra et al (2010) concluded that long-term testosterone therapy in FtM patients can contribute to "an increased atherogenic lipid profile by lowering HDL and possibly reducing serum leptin levels." Actual or perceived drops in leptin can cause increased food consumption and decreased energy expenditure, which could increase one's chances of developing or worsening CV risk factors such as dyslipidemia and diabetes mellitus (Kanaya Note.…”

“…Several authors have noted that there are significant gaps in knowledge regarding the side effects of testosterone administered over years or decades (Chandra, Basra, Chen, & Tangpricha, 2010;Elamin et al, 2010;Meriggiola & Berra, 2012). There are worries that using testosterone can increase FtM patients' vulnerability to CV disease, especially if they have other CV risk factors (Moore, Wisniewski, & Dobs, 2003).…”