Dynamic Impact of Hormone Therapy on Laboratory Values in Transgender Patients over Time

Abstract

Background Known physiological changes occur while transgender patients are taking hormone therapy (HT). However, knowledge is limited about when laboratory values stabilize and if there are any long-term impacts, making it challenging for physicians to provide adequate gender-affirming care. We aim to analyze laboratory values with HT use over 5 years and after discontinuation of HT to define when values achieve stability. Methods We performed a multicenter retrospective analysis of 126 transgender women (TW) and 91 transgender men (TM) at consecutive clinic visits. Labs included complete metabolic panel, complete blood count, lipids, and hormone levels and were monitored for 5 years. Absolute measurement and percentage change from baseline were calculated for each analyte value. We collected the laboratory studies described from patients off HT and the duration of discontinuation to determine the time to return to baseline levels. Results During HT, red blood cell (RBC; erythrocyte) indexes reach stable levels within 6 months (P < 0.001) and are unchanged long term. Some analytes such as HDL and platelets showed increases beyond the first year of HT in TW (P = 0.001 and P < 0.001, respectively). LDL and alanine aminotransferase increased beyond 1 year in TM (P < 0.005 and P < 0.001, respectively), whereas HDL decreased beyond 1 year (P < 0.001). Time for laboratory values to return to baseline occurred around 10 weeks. Conclusions Most analytes reach stable levels within 6 months (RBC and creatinine), whereas others change in the long term (LDL, HDL, platelets). This information can be used to guide physicians as they monitor their transgender patients in all stages of their progress through HT.

Gender‐affirming hormone therapy: An updated literature review with an eye on the future

“…High-density lipoprotein (HDL) cholesterol decreased by 10.8% (95% CI −14.0 to −7.6). Similar results were reported by Liu et al (Taiwan) and Allen et al (Dallas, Texas) [93,94] with an increase in LDL cholesterol and a decrease in HDL cholesterol in trans men during the first year of testosterone therapy. Liu et al [93] examined the effects of 1 year of testosterone therapy in trans men (n = 65, mean age = 27.9) and found an increase in LDL cholesterol from 124.3 mg/dl to 131.3 mg/dl and a decrease in HDL cholesterol from 57.9 mg/dl to 52.8 mg/dl.…”

“…Along the same lines, Allen et al. [94] reported increases of hematocrit levels in trans men ( n = 91, mean age = 27.8) during testosterone treatment and decreases in trans women ( n = 126, mean age = 31.1) during estrogen treatment with or without an anti‐androgen, with no changes after 6 months of therapy when compared to measurements after 5 years of GAHT. A similar pattern was shown in 183 trans women and 119 trans men with follow‐up longer than 6 months [103].…”

“…Similarly, Allen et al. found no significant changes in LDL cholesterol, HDL cholesterol, or triglycerides ( n = 126, mean age = 31.1) [94]. In a retrospective study, trans women (mean age = 34.4) on either spironolactone ( n = 82) or CPA ( n = 31) were compared with regard to the effects on HDL cholesterol [98].…”

“…Liu et al showed a trend decrease of LDL cholesterol from 104.2 to 100.4 mg/dl and a trend increase of HDL cholesterol from 63.9 to 65.0 mg/dl in trans women (n = 45, mean age = 26.0) during the first year of GAHT. Similarly, Allen et al found no significant changes in LDL cholesterol, HDL cholesterol, or triglycerides (n = 126, mean age = 31.1) [94]. In a retrospective study, trans women (mean age = 34.4) on either spironolactone (n = 82) or CPA (n = 31) were compared with regard to the effects on HDL cholesterol [98].…”

Characteristics of Transgender Women Referred to Women's Heart Clinic

“…As in assessment of thrombotic risks, the effects of GAHT on lipid panels are difficult to summarize due to study and treatment heterogeneity. One study showed a decrease in LDL, HDL, and triglycerides, [27] whereas other studies have shown no significant difference, [28] an effect on HDL alone, [29] or a significant change in triglycerides alone. [5] Coadministration of progestins and anti-androgens may be the cause of some conflicting results, and more data are needed before conclusions can be drawn.…”