detrans.ai 

Back to studies

Endocrine Societyn oma katsaus: vain heikkolaatuista näyttöä hormonien sydänriskeistä, vähän tutkittuja tapahtumia

Sukupuolihormonit ja sydän- ja verisuonitulokset transsukupuolisilla: järjestelmällinen katsaus ja meta-analyysi

Systemaattiset ja evidenssikatsauksetVastasukupuolihormonit
Authors
Spyridoula Maraka, Naykky Singh Ospina, Rene Rodriguez-Gutierrez, Caroline J. Davidge-Pitts, Todd B. Nippoldt, Larry J. Prokop, M. Hassan Murad
Journal
The Journal of Clinical Endocrinology & Metabolism
Year
2017
Source
https://doi.org/10.1210/jc.2017-01643

Summary

To prepare its 2017 guideline on hormone treatment for trans people, the Endocrine Society (a body of hormone doctors) paid Mayo Clinic reviewers to gather all studies on cross-sex hormones and heart health. They found 29 studies. Almost all simply observed patients, and many had no comparison group. Testosterone in trans men worsened cholesterol, raising 'bad' cholesterol and blood fats and lowering 'good' cholesterol. Estrogen in trans women raised blood fats. Heart attacks, strokes, blood clots and deaths were too rarely reported to measure risk, though they were more common in trans women. The reviewers judged the evidence low quality. The review mainly shows how little was known about heart safety when the guideline was written. Larger studies published since (for example Getahun 2018 and Nota 2019) are not included.

Key findings

  • Katsauksen maksoi Endocrine Society tukemaan sen vuoden 2017 ohjetta sukupuolidysforian (ahdistus omasta sukupuolesta) hoidosta hormoneilla.
  • Se sisälsi 29 tutkimusta, jotka kattoivat 3 231 transnaista ja 1 500 transmiestä; vain 1 jakoi hoidon satunnaisesti, 17 vain vertasi ihmisiä ennen ja jälkeen, ja vain 4:llä oli vertailuryhmä.
  • Transmiehillä 2 tai useamman vuoden jälkeen testosteroni liittyi korkeampiin veren rasvoihin (triglyseridit, nousu 21,4 mg/dL), korkeampaan ”huonoon” kolesteroliin (nousu 17,8 mg/dL) ja matalampaan ”hyvään” kolesteroliin (lasku jopa 8,5 mg/dL).
  • Transnaisilla veren rasvat olivat korkeampia 2 tai useamman vuoden jälkeen (nousu 31,9 mg/dL), eikä kolesterolissa ollut selvää muutosta.
  • Transnaisten osalta tutkimukset raportoivat 56 veritulppaa 1 767:llä, 14 sydänkohtausta 1 073:lla, 8 aivohalvausta 859:llä ja 139 kuolemaa 1 486:lla, mukaan lukien 23 sydänkuolemaa ja 26 itsemurhaa.
  • Transmiesten osalta tutkimukset raportoivat vain 1 veritulpan 771:llä, 1 sydänkohtauksen 478:lla, ei aivohalvauksia 340:llä ja 13 kuolemaa 651:llä.
  • Arvioijat arvioivat kokonaisnäytön matalalaatuiseksi, todennäköisesti valikoivan raportoinnin vaikutuksen alaiseksi, ja potilaille tärkeimmistä terveystapahtumista oli vain vähän tietoa.

Abstract

BACKGROUND: Transgender individuals receive cross-sex hormonal therapy to induce desired secondary sexual characteristics despite limited data regarding its effects on cardiovascular health. METHODS: A comprehensive search of several databases up to 7 April 2015 was conducted for studies evaluating the effect of sex steroid use on lipids, myocardial infarction, stroke, venous thromboembolism (VTE), and mortality in transgender individuals. Pairs of reviewers selected and appraised the studies. A random-effects model was used to pool weighted mean differences and 95% confidence intervals (CIs). RESULTS: We found 29 eligible studies with moderate risk of bias. In female-to-male (FTM) individuals, sex steroid therapy was associated with statistically significant increases in serum triglyceride (TG) levels at 3 to 6 months and at ≥24 months (21.4 mg/dL; 95% CI: 0.14 to 42.6) and in low-density lipoprotein cholesterol (LDL-C) levels at 12 months and ≥24 months (17.8 mg/dL; 95% CI: 3.5 to 32.1). High-density lipoprotein cholesterol (HDL-C) levels decreased significantly across all follow-up periods (highest at ≥24 months, -8.5 mg/dL; 95% CI: -13.0 to -3.9). In male-to-female (MTF) individuals, serum TG levels were significantly higher at ≥24 months (31.9 mg/dL; 95% CI: 3.9 to 59.9) without any changes in other parameters. Few myocardial infarction, stroke, VTE, and death events were reported (more frequently in MTF individuals). CONCLUSIONS: Low-quality evidence suggests that sex steroid therapy may increase LDL-C and TG levels and decrease HDL-C level in FTM individuals, whereas oral estrogens may increase TG levels in MTF individuals. Data about important patient outcomes remain sparse.

Conclusion

Low-quality evidence suggests that sex steroid therapy may increase LDL-C and TG levels and decrease HDL-C level in FTM individuals, whereas oral estrogens may increase TG levels in MTF individuals. Data about important patient outcomes remain sparse.