MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people

Glintborg, Dorte; T’Sjoen, Guy; Ravn, Pernille; Andersen, Marianne

doi:10.1530/eje-21-0059

Cited by 39 publications

(34 citation statements)

References 108 publications

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“…This treatment pattern is similar to European countries where cyproterone acetate is the most commonly prescribed androgen-lowering medication. 23 Spironolactone is commonly used in the United States, where cyproterone acetate is unavailable. 6 Dosing several tablets per day and the potential side effect of hyperkalemia limit the utility.…”

Section: Discussionmentioning

confidence: 99%

The Real-World Characteristics of Gender-Affirming Hormonal Use Among Transgender People in Thailand

et al. 2022

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Background Most Thai transgender people (TG) do not use gender-affirming hormone therapy (GAHT) under medical supervision. Aim To understand the current real-world characteristics of GAHT among TG. Methods A cross-sectional survey was conducted using an online questionnaire between September and December 2020. TG, who resided in Thailand for more than 1 year, were included. Self-reported demographic data and characteristics of GAHT were obtained. The reported GAHT were compared to the reference regimen recommended by the 2017 Endocrine Society Clinical Practice Guideline. Outcomes The characteristics of GAHT used among TG and factors associated with hormonal use outside the reference regimen were reported. Results A total of 401 TG were included in the analysis. Of these, 249 (62%) were transgender men (TM). Most TM (81%) and transgender women (88%) were using GAHT. Only 297 TG provided a complete hormone regimen. A total of 224 TG (75%) used GAHT outside the reference regimen. The main reasons in TM were using intramuscular testosterone with a higher dose per injection and less frequent intervals. In transgender women, using oral contraceptive pills and cyproterone acetate 12.5 mg/d were the two most common reasons. A univariate analysis revealed factors associated with hormonal use outside the reference regimen, including age at a survey participation (OR 1.04, 95%CI 1.00–1.08, P = .047), age at hormone initiation (OR 1.04, 95%CI 1.01–1.08, P = .015), TM (OR 2.08, 95%CI 1.22–3.56, P = .007) and using GAHT, not under medical supervision (OR 1.78, 95%CI 1.04–3.05, P = .037). The multivariate analysis showed that only living outside the capital city was solely statistically significant (AOR 1.77, 95%CI 1.02–3.05, P = .041). Clinical Implications Enhancing health literacy in GAHT among TG is crucial, especially TG not living in the capital city. Strengths and Limitations This study demonstrates a current real-world practice of GAHT use among TG, both under and not under medical care. However, the causality could not be concluded due to the nature of the cross-sectional observation study, and results come with a recall bias. Conclusion There is a high prevalence of GAHT use outside the reference regimen. The only factor associated with hormonal use outside the reference regimen is living outside the capital city.

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Section: Discussionmentioning

confidence: 99%

The Real-World Characteristics of Gender-Affirming Hormonal Use Among Transgender People in Thailand

et al. 2022

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“…Importantly, no data are available to establish specific serologic data with estradiol efficacy or safety during feminizing hormone therapy (e.g. breast development and cardiovascular risks) ( 16 , 31 ), which is essential to justify therapeutic monitoring of any drug ( 32 ). Given the potential for interference by exogenous estradiol and negative bias reported in our analysis, these factors need to be examined collectively for laboratory scientists to make informed recommendations on how to determine estradiol concentrations in clinical settings and when to dose-adjust estradiol treatment among transgender patients.…”

Section: Discussionmentioning

confidence: 99%

Oral estrogen leads to falsely low concentrations of estradiol in a common immunoassay

Cirrincione

Crews

Dickerson

et al. 2022

Endocrine Connections

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Objectives: Recently, an estradiol immunoassay manufacturer (Beckman Coulter, USA) issued an “Important Product Notice” alerting clinical laboratories their assay (Access Sensitive Estradiol) was not indicated for patients undergoing exogenous estradiol treatment. The objective of this analysis was to evaluate immunoassay bias relative to liquid chromatography tandem mass spectrometry (LC-MS/MS) in transgender women and to examine the influence of unconjugated estrone on measurements. Design: Cross sectional secondary analysis. Methods: Estradiol concentrations from 89 transgender women were determined by three immunoassays (Access Sensitive Estradiol [‘New BC’] and Access Estradiol assays [‘Old BC’], Beckman Coulter; Estradiol III assay [‘Roche’], Roche Diagnostics) and LC-MS/MS. Bias was evaluated with and without adjustment for estrone concentrations. The number of participants who shifted between three estradiol concentration ranges for each immunoassay versus LC-MS/MS (>300 pg/mL, 70-300 pg/mL, and <70 pg/mL) was calculated. Results: The New BC assay had the largest magnitude overall bias (median: -34%) and was -40%, -22%, and -10%, among participants receiving tablet, patch, or injection preparations, respectively. Overall bias was -12% and +17% for the Roche and Old BC assays, respectively. When measured with the New BC assay, 18 participants shifted to a lower estradiol concentration range (versus 9 and 10 participants based on Roche or Old BC assays, respectively). Adjustment for estrone did not minimize bias. Conclusions: Immunoassay measurement of estradiol in transgender women may lead to falsely decreased concentrations that have the potential to affect management. A multi-disciplinary health care approach is needed to ensure appropriate analytical methods are available.

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“…However, there are increasing data in favor of the use of progesterone and its derivatives in transgender women for feminization, bone health and mood disorders. Data regarding cardiovascular safety remain scarce [ 22 , 23 ].…”

Section: Cardiovascular Healthmentioning

confidence: 99%

The effects of gender-affirming hormone therapy on cardiovascular and skeletal health: A literature review

et al. 2022

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MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people

Cited by 39 publications

References 108 publications

The Real-World Characteristics of Gender-Affirming Hormonal Use Among Transgender People in Thailand

The Real-World Characteristics of Gender-Affirming Hormonal Use Among Transgender People in Thailand

Oral estrogen leads to falsely low concentrations of estradiol in a common immunoassay

The effects of gender-affirming hormone therapy on cardiovascular and skeletal health: A literature review

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