How Does Gender-Affirming Hormone Treatment Affect the Metabolic Profile in Transgender Individuals?

After careful consideration, the Endocrine Society canceled its annual meeting (ENDO 2020), which was set to take place in San Francisco, California, from March 28 to 31, 2020, because of concerns regarding coronavirus disease 2019 (COVID-19). Research findings that were scheduled to be presented at the meeting have been published in a supplemental issue of the Journal of the Endocrine Society. The society is hosting ENDO Online, a complimentary virtual event featuring on-demand and live programming, from June 8 to 22, 2020, to provide a platform for continued learning and research exhibition. For more information, visit the Endocrine Society’s website.

Cross-sex hormone therapy has a negative effect on lipid profile and glucose levels in transgender men, but this negative effect may not occur in transgender women, according to study results intended to be presented at the annual meeting of the Endocrine Society (ENDO 2020).

Research has shown that sex hormone therapy can have a significant effect on lipid metabolism and weight in cisgender persons, but limited data exist on the effects of higher doses of cross-sex hormone therapy on these parameters in transgender men and women. The goal of the current study was to explore the effects of gender-affirming hormone therapy on lipid metabolism in transgender individuals.

The retrospective chart review included transgender patients treated at an academic medical center, excluding patients who were started on lipid-lowering therapy after baseline.

The study cohort included 18 transgender women (mean age, 33±13 years; mean duration of hormone therapy, 10.1±4.5 months) and 22 transgender men (mean age, 28±12 years; mean duration of hormone therapy, 6.7±4.4 months) with available laboratory data.

All transgender women were treated with estradiol, most often with an oral preparation (78%) or a patch (11%), as well as spironolactone. In this group, there was a significant 10% increase in high-density lipoprotein level (from 48±17 to 53±15 mg/dL; P =.02), but there was no change in other lipid fractions, glycated hemoglobin, or weight.

Most transgender men (82%) received weekly testosterone-esters injections, whereas the remainder were treated with daily testosterone gel. In this group, cross-sex hormone therapy had a negative effect on the metabolic profile, with a 15% decrease in high-density lipoprotein level (from 55±15 to 47±10 mg/dL; P =.004), an increase in glycated hemoglobin (from 5.07%±0.45% to 5.22%±0.39%; P =.04) and body mass index (from 29±10 to 31±10 kg/m²; P =.002), and a trend toward increased triglycerides (from 96±64 to 110±80 mg/dL; P =.07). In addition, there was a significant increase in hemoglobin and hematocrit in this group.

No significant changes in liver function tests were reported in either group.

The researchers acknowledged several study limitations, including the small sample size and missing data on body composition to assess the changes in adipose tissue or muscle mass.

“Clinicians should inform [transgender men] about these potential negative effects of [cross-sex hormone therapy] on lipid metabolism so that their patients can adopt healthy lifestyle interventions early on to optimize their cardiovascular risk,” wrote the researchers.

Reference

Kelley C, Coviello AD. Effects of cross-sex hormone therapy on lipid metabolism in transgender women and men. J Endocr Soc. 2020;4(suppl 1):SUN-052.

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