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내분비학회 자체 검토: 호르몬의 심장 위험에 대한 근거는 질이 낮고 다룬 사건도 적음

트랜스젠더 개인의 성 스테로이드와 심혈관 결과: 체계적 문헌고찰 및 메타분석

체계적 및 증거 검토교차성호르몬
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

  • 검토는 호르몬으로 성별 불쾌감(자신의 성에 대한 고통)을 치료하는 2017년 지침을 뒷받침하기 위해 내분비학회가 비용을 댔습니다.
  • 트랜스 여성 3,231명과 트랜스 남성 1,500명을 다룬 연구 29건이 포함되었습니다. 치료를 무작위로 배정한 것은 1건뿐이었고, 17건은 사람들의 전후만 비교했으며, 비교 집단이 있었던 것은 4건뿐이었습니다.
  • 트랜스 남성에서 2년 이상 후 테스토스테론은 더 높은 혈중 지방(중성지방, 21.4 mg/dL 상승), 더 높은 ‘나쁜’ 콜레스테롤(17.8 mg/dL 상승), 더 낮은 ‘좋은’ 콜레스테롤(최대 8.5 mg/dL 하락)과 관련이 있었습니다.
  • 트랜스 여성에서는 2년 이상 후 혈중 지방이 더 높았고(31.9 mg/dL 상승), 콜레스테롤에는 뚜렷한 변화가 없었습니다.
  • 트랜스 여성에서 연구들은 1,767명 중 혈전 56건, 1,073명 중 심장마비 14건, 859명 중 뇌졸중 8건, 1,486명 중 사망 139건(심장 관련 사망 23건과 자살 26건 포함)을 보고했습니다.
  • 트랜스 남성에서 연구들은 771명 중 혈전 1건, 478명 중 심장마비 1건, 340명 중 뇌졸중 없음, 651명 중 사망 13건만 보고했습니다.
  • 검토자들은 전반적인 근거를 선택적 보고의 영향을 받았을 가능성이 있는 낮은 품질로 평가했으며, 환자에게 가장 중요한 건강 사건에 대한 자료가 거의 없습니다.

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.