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내분비학회 검토: 호르몬 사용 중 단기 골밀도 변화는 적지만 골절 자료는 거의 없음

성 스테로이드가 트랜스젠더 개인의 뼈 건강에 미치는 영향: 체계적 문헌고찰 및 메타분석

체계적 및 증거 검토교차성호르몬
Authors
Naykky Singh-Ospina, Spyridoula Maraka, Rene Rodriguez-Gutierrez, Caroline Davidge-Pitts, Todd B. Nippoldt, Larry J. Prokop, Mohammad Hassan Murad
Journal
The Journal of Clinical Endocrinology & Metabolism
Year
2017
Source
https://doi.org/10.1210/jc.2017-01642

Summary

This review was one of the evidence reviews behind the Endocrine Society's 2017 guideline on treating gender dysphoria (distress about one's sex). The Mayo Clinic team combined 13 studies (639 people, mostly adults) that measured bone density before and after cross-sex hormones. Testosterone in females made no measurable difference to spine or hip bone density over one to two years. Estrogen in males slightly raised spine bone density. Only one study looked at broken bones (none in a year), and only one looked at teenagers given puberty blockers (drugs that pause puberty) and then hormones. That study found males had lower spine bone density at age 22 than before treatment. The authors said the effect on the risk of broken bones is uncertain. The review is reassuring about short-term bone density in adults, but cannot show long-term safety, fracture risk, or safety for teenagers.

Key findings

  • 검토는 639명(출생 시 남성 392명, 여성 247명)을 다룬 연구 13건을 합쳤습니다.
  • 테스토스테론을 쓰는 여성에서 아래쪽 척추와 고관절의 골밀도는 1년 또는 2년 후 측정 가능한 변화가 없었습니다.
  • 에스트로겐을 쓰는 남성에서 아래쪽 척추 골밀도는 1년 후 약간 올랐고 2년 후 조금 더 올랐습니다.
  • 골절을 살핀 연구는 남성 53명과 여성 53명을 대상으로 한 한 건뿐이었고, 12개월 동안 골절은 없었습니다.
  • 사춘기 차단제를 받고 이후 호르몬을 받은 10대를 다룬 연구는 한 건뿐이었고, 남성은 22세에 척추 골밀도가 치료 전보다 낮았다고 밝혔습니다.
  • 저자들은 근거 대부분이 오도할 위험이 중간 정도인 연구에서 왔으며 골절 위험에 대한 영향은 불확실하다고 말했습니다.
  • 검토는 내분비학회를 위해, 그 전문가들과 세운 계획에 따라 2017년 지침을 뒷받침하기 위해 수행되었습니다.

Abstract

BACKGROUND: The impact of sex steroids on bone health in transgender individuals is unclear.

METHODS: A comprehensive search of several databases to 7 April 2015 was conducted for studies evaluating bone health in transgender individuals receiving sex steroids. Pairs of reviewers selected and appraised studies. A random effects model was used to pool weighted mean differences and 95% confidence intervals (CIs).

RESULTS: Thirteen studies evaluating 639 transgender individuals were identified [392 male-to-female (MTF), 247 female-to-male (FTM)]. In FTM individuals and compared with baseline values before initiation of masculinizing hormone therapy, there was no statistically significant difference in the lumbar spine, femoral neck, or total hip bone mineral density (BMD) when assessed at 12 and 24 months. In MTF individuals and compared with baseline values before initiation of feminizing hormone therapy, there was a statistically significant increase in lumbar spine BMD at 12 months (0.04 g/cm2; 95% CI, 0.03 to 0.06 g/cm2) and 24 months (0.06 g/cm2; 95% CI, 0.04 to 0.08 g/cm2). Fracture rates were evaluated in a single cohort of 53 MTF and 53 FTM individuals, with no events at 12 months. The body of evidence is derived mostly from observational studies at moderate risk of bias.

CONCLUSION: In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.

Conclusion

In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.