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Tinjauan Endocrine Society Sendiri: Hanya Bukti Berkualitas Rendah soal Risiko Jantung Hormon, dengan Sedikit Kejadian

Steroid seks dan luaran kardiovaskular pada individu transgender: tinjauan sistematis dan meta-analisis

Tinjauan sistematis & buktiHormon lintas jenis kelamin
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

  • Tinjauan ini dibiayai oleh Endocrine Society untuk mendukung pedoman 2017-nya tentang pengobatan disforia gender (tekanan batin tentang jenis kelamin seseorang) dengan hormon.
  • Tinjauan ini mencakup 29 studi dengan 3.231 wanita trans dan 1.500 pria trans; hanya 1 yang menetapkan perawatan secara acak, 17 hanya membandingkan orang sebelum dan sesudah, dan hanya 4 yang memiliki kelompok pembanding.
  • Pada pria trans, setelah 2 tahun atau lebih, testosteron terkait dengan lemak darah yang lebih tinggi (trigliserida, naik 21,4 mg/dL), kolesterol 'jahat' yang lebih tinggi (naik 17,8 mg/dL), dan kolesterol 'baik' yang lebih rendah (turun hingga 8,5 mg/dL).
  • Pada wanita trans, lemak darah lebih tinggi setelah 2 tahun atau lebih (naik 31,9 mg/dL), tanpa perubahan kolesterol yang jelas.
  • Di antara wanita trans, studi melaporkan 56 bekuan darah pada 1.767 orang, 14 serangan jantung pada 1.073, 8 stroke pada 859, dan 139 kematian pada 1.486, termasuk 23 kematian terkait jantung dan 26 bunuh diri.
  • Di antara pria trans, studi hanya melaporkan 1 bekuan darah pada 771, 1 serangan jantung pada 478, tidak ada stroke pada 340, dan 13 kematian pada 651.
  • Para peninjau menilai bukti secara keseluruhan berkualitas rendah, kemungkinan dipengaruhi oleh pelaporan selektif, dengan sedikit data tentang kejadian kesehatan yang paling penting bagi pasien.

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.