Early onset of hyperuricaemia and gout following treatment for female to male gender reassignment

Testosterone replacement elevates the serum uric acid levels in patients with female to male gender identity disorder

“…Estrogen replacement therapy also reduces the serum UA concentrations in hyperuricemic postmenopausal females [11]. With respect to TRT, only two reports have shown that testosterone treatment for female to male gender reassignment leads to increased serum UA concentrations and reduced renal excretion of UA [12,13]. Our current study also demonstrated serum UA upregulation induced by testosterone administration.…”

“…Several authors have previously examined the influence of testosterone and estradiol on the serum UA level [10][11][12][13]. A study of patients undergoing male to female gender reassignment reported that estrogen replace- also indicates an association between the UA level and cardiovascular morbidity and suggests that mortality is greater in females than in males in middle life [23].…”

“…We experienced that, when TRT is initiated, testosterone immediately affects the systemic metabolism in female to male GID patients. Although UA is a possible factor that can be influenced by testosterone administration [10][11][12][13], the early effects and dose-dependency of TRT on the serum UA concentration have not been previously determined. As for the effects of testosterone on the serum UA level, we herein report our experience using three TRT doses in the treatment of female to male GID.…”

“…As for the mechanisms underlying the TRT-induced increases in the serum UA concentration, it seems likely that sex hormones primarily influence the serum UA concentration via changes in renal UA excretion [10][11][12][13]. Testosterone and estradiol exhibit suppressing and enhancing effects, respectively, on renal UA excretion, and this theory also explains age and sex differences in the serum UA levels.…”

Analysis of Uric Acid Elevation

“…Estrogen replacement therapy in those who undergo male-to-female gender reassignment reduces serum uric acid concentrations and increases uric acid excretion in the urine (39). Considering the mechanisms underlying the increases in serum uric acid concentration induced by testosterone replacement therapy, it is possible that sex hormones affect serum uric acid concentrations by influencing renal uric acid excretion (38,(40)(41)(42). Testosterone and estradiol display inhibitory and enhancing effects, respectively, on the renal excretion of uric acid and this theory also explains the age and gender differences in serum uric acid levels (38).…”