detrans.ai 

Back to studies

Revisione dell'Endocrine Society stessa: solo prove di bassa qualità sui rischi cardiaci degli ormoni, pochi eventi

Steroidi sessuali ed esiti cardiovascolari nelle persone transgender: revisione sistematica e meta-analisi

Revisioni sistematiche e delle evidenzeOrmoni cross-sex
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

  • La revisione è stata pagata dall'Endocrine Society a sostegno della sua linea guida del 2017 sul trattamento della disforia di genere (disagio per il proprio sesso) con gli ormoni.
  • Ha incluso 29 studi su 3.231 donne trans e 1.500 uomini trans; solo 1 assegnava casualmente il trattamento, 17 confrontavano soltanto le persone prima e dopo e solo 4 avevano un gruppo di confronto.
  • Negli uomini trans, dopo 2 o più anni, il testosterone era associato a grassi nel sangue più alti (trigliceridi, +21,4 mg/dL), a colesterolo «cattivo» più alto (+17,8 mg/dL) e a colesterolo «buono» più basso (fino a −8,5 mg/dL).
  • Nelle donne trans, i grassi nel sangue erano più alti dopo 2 o più anni (+31,9 mg/dL), senza un chiaro cambiamento del colesterolo.
  • Tra le donne trans, gli studi riportavano 56 coaguli di sangue in 1.767 persone, 14 infarti in 1.073, 8 ictus in 859 e 139 decessi in 1.486, tra cui 23 decessi legati al cuore e 26 suicidi.
  • Tra gli uomini trans, gli studi riportavano solo 1 coagulo di sangue in 771, 1 infarto in 478, nessun ictus in 340 e 13 decessi in 651.
  • I revisori hanno giudicato di bassa qualità le prove complessive, probabilmente influenzate da una segnalazione selettiva, con pochi dati sugli eventi di salute più importanti per i pazienti.

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.