Effect of cross-sex hormone treatment on cardiovascular risk factors in transsexual individuals. Experience in a specialized unit in Catalonia

Quirós, Carmen; Patrascioiu, Ioana; Mora, Mireia; Aranda, Gloria; Hanzu, Felicia A.; Gómez‐Gil, Esther; Godás, Teresa; Halperín, Irene

doi:10.1016/j.endoen.2015.05.004

Cited by 6 publications

(11 citation statements)

References 17 publications

(15 reference statements)

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“…The prevalence of smoking was high in the five studies that reported this cardiovascular risk factor: 37% (Mueller et al ., ), 30% (Chandra et al ., ), 51% (Pelusi et al ., ), 20% (Wierckx et al ., ), and 60% (Quirós et al ., ). Slight but significant increases in BMI were observed in most studies, ranging from 1.3 to 11.4%, during testosterone treatment (Table ).…”

Section: Resultsmentioning

confidence: 97%

“…After this step, three articles were excluded because the variables of interest were not reported, and one because a progestin was added to androgen treatment. Thirteen articles were thus included in the systematic review (Giltay et al ., ; Berra et al ., ; Jacobeit et al ., , ; Mueller et al ., , ; Chandra et al ., ; Cupisti et al ., ; Pelusi et al ., ; Wierckx et al ., ; Deutsch et al ., ; Quirós et al ., ; Fisher et al ., ).…”

Section: Resultsmentioning

confidence: 98%

“…As shown in Table , study duration ranged from 6 to 60 months, sample size ranged from 12 to 97 patients, and the most common treatment was parenteral testosterone undecanoate 1000 mg/12 weeks, which was reported in eight of 13 articles (Jacobeit et al ., , ; Mueller et al ., , ; Cupisti et al ., ; Pelusi et al ., ; Wierckx et al ., ; Quirós et al ., ; Fisher et al ., ). The design of most studies was observational (non‐controlled).…”

Section: Resultsmentioning

confidence: 98%

“…Most of the studies followed a protocol in which a second injection of testosterone undecanoate was prescribed 6 weeks after the first administration, with subsequent 1000 mg injections recommended every 12 weeks. However, one study (Quirós et al ., ) prescribed either intramuscular testosterone undecanoate 1000 mg or 1% transdermal gel, according to patient preference and depending on the patient's clinical condition. Other testosterone formulations were also prescribed: testosterone patch (4 mg/day) (Deutsch et al ., ), testosterone gel (1%, 5 g/day) (Deutsch et al ., ; Quirós et al ., ), testosterone cypionate (Chandra et al ., ; Deutsch et al ., ); testosterone enanthate (100 mg) associated with testosterone propionate (25 mg/10 days) (Berra et al ., ; Fisher et al ., ); testosterone esters (250 mg/2 weeks); and oral testosterone undecanoate (160–240 mg/day) (Giltay et al ., ) (Table ).…”

Section: Resultsmentioning

confidence: 99%

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Effects of testosterone therapy on BMI, blood pressure, and laboratory profile of transgender men: a systematic review

et al. 2017

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Testosterone is the main hormonal agent used for cross-sex hormone therapy in female-to-male transgender persons. Our aim was to systematically review the literature concerning the effects of testosterone on body mass index (BMI), blood pressure, hematocrit, hemoglobin, lipid profile, and liver enzymes in transgender men. PUBMED and EMBASE were searched for studies published until March 2017. Studies were included if they reported interventions with any dose of testosterone and comparison of variables before and during treatment. Of 455 potentially eligible articles, 13 were reviewed. Study duration ranged from 6 to 60 months, sample size ranged from 12 to 97 patients, and the most common treatment was parenteral testosterone undecanoate 1000 mg/12 weeks. Slight but significant increases in BMI were reported (from 1.3 to 11.4%). Three out of seven studies assessing the impact of different testosterone formulations on blood pressure detected modest increases or clinically irrelevant changes in this variable. In another study, however, two patients developed hypertension, which was resolved after cessation of testosterone therapy. Decreases in HDL-cholesterol and increases in LDL-cholesterol were consistently observed. Eight studies observed a relationship between testosterone and increased hemoglobin (range: 4.9-12.5%) and hematocrit (range: 4.4-17.6%), but discontinuation of androgen therapy was not necessary. In one study, two patients developed erythrocytosis (hematocrit >52%) after 9 and 12 months of treatment. One study analyzing testosterone formulations observed smaller increases in hemoglobin and hematocrit with testosterone gel. Six studies assessing liver function showed slight or no changes. Overall, the quality of evidence was low, given the lack of randomized clinical/controlled trials and the small sample sizes. In conclusion, exogenous testosterone administration to transgender men was associated with modest increases in BMI, hemoglobin/hematocrit, and LDL-cholesterol, and with decreases in HDL-cholesterol. Long-term studies are needed to assess the long-term risks of testosterone therapy, particularly as they relate to cardiometabolic risks such as diabetes, dyslipidemia and the metabolic syndrome.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

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Effects of testosterone therapy on BMI, blood pressure, and laboratory profile of transgender men: a systematic review

et al. 2017

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“…One of the most prominent changes seen in the routine laboratory monitoring of trans persons is a change in hematocrit and hemoglobin: a decrease in trans women (Schlatterer et al ., ; Roberts et al ., ; Quirós et al ., ; Tack et al ., ) and an increase in trans men (Schlatterer et al ., ; Jacobeit et al ., ; Chandra et al ., ; Mueller et al ., ; Pelusi et al ., ; Quirós et al ., ; Jarin et al ., ). As in hypogonadal men on testosterone treatment, the induction of erythrocytosis in trans men on testosterone treatment is of concern because it might be associated with an elevated thrombotic risk.…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of hematocrit in gender‐affirming hormone treatment: results from European Network for the Investigation of Gender Incongruence

et al. 2018

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In trans persons on gender-affirming hormonal treatment, a decrease (in trans women) or increase (in trans men) in hematocrit is often observed. Reference ranges for evaluation of hematocrit levels in trans persons have not been established. This prospective cohort study is part of the European Network for the Investigation of Gender Incongruence (ENIGI). At the Ghent and Amsterdam sites, we included 625 hormone-naïve trans persons. Gender-affirming hormonal treatment was initiated at the first visit. In trans men, serum hematocrit (Hct) levels increased during the first year (+4.9 Hct %, 95% CI 3.82-5.25), with the most pronounced increase during the first 3 months (+2.7 Hct %, 95% CI 1.94-3.29). Trans men receiving testosterone esters had a larger increase in serum hematocrit levels compared to trans men receiving testosterone undecanoate (Δ 0.8 Hct %). Of 192 trans men, 22 (11.5%) developed serum hematocrit levels ≥50.0%. Trans men on testosterone undecanoate were less likely to develop hematocrit levels ≥50% or ≥52%, compared to trans men on testosterone esters, and were less likely to develop hematocrit levels ≥50%, compared to trans men on testosterone gel. In trans women, serum hematocrit had dropped by 4.1 Hct % (95% CI 3.50-4.37) after 3 months, after which only small decreases were observed. In conclusion, serum hematocrit levels can be found in the reference range of the perceived gender as from 3 months after the initiation of gender-affirming hormonal treatment.

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Diagnosis, Treatment, and Prevention of Stroke in Transgender Adults

Diaz

Rosendale

2022

Curr Treat Options Neurol

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Purpose of Review To identify the current state of science on stroke in transgender adults and highlight gaps in need of further research. We will review current research on cerebrovascular risk and disease, hormone therapy, and stroke in transgender individuals. Finally, we will provide a framework for healthcare providers to prevent and reduce disparities through inclusive care practices. Recent Findings Transgender people experience unique stroke risk factors, secondary to both psychosocial stress and health-related behaviors. These include higher rates of HIV, tobacco use, stimulant use, and hepatitis C. The use of gender-affirming hormone therapy may lead to an increased risk for ischemic stroke, but the data are limited and require further research. Summary Recent research has highlighted the numerous healthcare disparities faced by transgender individuals. Regarding stroke disparities, these are multifactorial and include contributions from health-related behaviors, inadequate access to care, the use of hormonal therapy, and minority stress. Further research is needed to increase access to care and reduce the substantial gap in outcomes for these individuals.

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Effect of cross-sex hormone treatment on cardiovascular risk factors in transsexual individuals. Experience in a specialized unit in Catalonia

Cited by 6 publications

References 17 publications

Effects of testosterone therapy on BMI, blood pressure, and laboratory profile of transgender men: a systematic review

Effects of testosterone therapy on BMI, blood pressure, and laboratory profile of transgender men: a systematic review

Prospective evaluation of hematocrit in gender‐affirming hormone treatment: results from European Network for the Investigation of Gender Incongruence

Diagnosis, Treatment, and Prevention of Stroke in Transgender Adults

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