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Testosteron Naikkan Sel Darah Merah pada Pria Trans: 38% Lewati Ambang Eritrositosis Laki-laki dalam 10 Tahun

Eritrositosis pada kohort besar pria trans yang memakai testosteron: studi tindak lanjut jangka panjang tentang prevalensi, determinan, dan tahun paparan

Studi kohort & registriHormon lintas jenis kelamin
Authors
Milou Cecilia Madsen, Dennis van Dijk, Chantal M. Wiepjes, Elfi B. Conemans, Abel Thijs, Martin den Heijer
Journal
The Journal of Clinical Endocrinology & Metabolism
Year
2021
Source
https://doi.org/10.1210/clinem/dgab089

Summary

Testosterone makes the body produce more red blood cells. Blood that becomes too thick raises the risk of clots, heart attack and stroke. Amsterdam doctors reviewed blood tests from 1,073 trans men on testosterone over up to 20 years. About one in nine had repeatedly high levels by male standards. The chance of ever crossing the limit kept rising for years, reaching 38% after a decade, so someone stable for years can still develop it. Long-acting injections, smoking, higher weight, older age and lung disease raised the risk. The authors advise checking blood for as long as testosterone is used. More than half of the clinic's trans men were left out for missing data. Using the normal limits for women would label far more people as affected (26%, the authors said in a reply to a letter), so the true scale may be higher.

Key findings

  • Dari 1.073 pria trans yang memakai testosteron, 11% memiliki darah terlalu kental (lebih dari separuh volume darah terdiri dari sel darah merah) pada dua tes menurut standar laki-laki; 3,7% dan 0,5% melewati batas yang lebih tinggi.
  • Sebanyak 24% memiliki setidaknya satu tes darah di atas batas laki-laki.
  • Rata-rata, proporsi darah yang terdiri dari sel darah merah naik dari 39% sebelum perawatan menjadi 45% setelah satu tahun, lalu hanya naik sedikit selama 20 tahun.
  • Di antara 776 pria dengan data awal, peluang pernah melampaui batas laki-laki mencapai 38% setelah 10 tahun dan 50% setelah 14 tahun.
  • Suntikan testosteron kerja panjang terkait dengan peluang darah terlalu kental sekitar 3 kali lipat dibandingkan gel; merokok (sekitar dua kali lipat peluang), berat badan lebih tinggi, usia mulai lebih tua, dan kondisi paru juga meningkatkan risiko.
  • Memakai batas normal untuk perempuan sebagai gantinya, 26% akan memenuhi syarat pada dua tes, kata para penulis dalam balasan terhadap surat yang diterbitkan.
  • Studi ini hanya mengukur tes darah, bukan kejadian kesehatan sebenarnya seperti bekuan darah atau serangan jantung.

Abstract

CONTEXT: Erythrocytosis is a known side effect of testosterone therapy that can increase the risk of thromboembolic events. OBJECTIVES: To study the prevalence and determinants in the development of erythrocytosis in trans men using testosterone. METHODS: A 20-year follow-up study in adult trans men who started testosterone therapy and had monitoring of hematocrit at our center (n = 1073). RESULTS: Erythrocytosis occurred in 11% (hematocrit > 0.50 L/L), 3.7% (hematocrit > 0.52 L/L), and 0.5% (hematocrit > 0.54 L/L) of trans men. Tobacco use (odds ratio [OR] 2.2; 95% CI, 1.6-3.3), long-acting undecanoate injections (OR 2.9; 95% CI, 1.7-5.0), age at initiation of hormone therapy (OR 5.9; 95% CI, 2.8-12.3), body mass index (BMI) (OR 3.7; 95% CI, 2.2-6.2), and pulmonary conditions associated with erythrocytosis and polycythemia vera (OR 2.5; 95% CI, 1.4-4.4) were associated with hematocrit > 0.50 L/L. In the first year of testosterone therapy hematocrit increased most: 0.39 L/L at baseline to 0.45 L/L after 1 year. Although there was only a slight continuation of this increase in the following 20 years, the probability of developing erythrocytosis still increased (10% after 1 year, 38% after 10 years). CONCLUSION: Erythrocytosis occurs in trans men using testosterone. The largest increase in hematocrit was seen in the first year, but also after the first years a substantial number of people present with hematocrit > 0.50 L/L. A reasonable first step in the care for trans men with erythrocytosis while on testosterone is to advise them to quit smoking, to switch to a transdermal administration route, and if BMI is high, to lose weight.

Conclusion

Erythrocytosis occurs in trans men using testosterone. The largest increase in hematocrit was seen in the first year, but also after the first years a substantial number of people present with hematocrit > 0.50 L/L. A reasonable first step in the care for trans men with erythrocytosis while on testosterone is to advise them to quit smoking, to switch to a transdermal administration route, and if BMI is high, to lose weight. The authors add that regular hematocrit control seems warranted for as long as testosterone is used.