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테스토스테론이 트랜스 남성의 적혈구 수치를 높임: 10년 안에 38%가 남성 적혈구증 기준을 넘음

테스토스테론을 쓰는 대규모 트랜스 남성 코호트의 적혈구증: 유병률, 결정 요인, 노출 연수에 대한 장기 추적 연구

코호트 및 등록 연구교차성호르몬
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

  • 테스토스테론을 쓰는 트랜스 남성 1,073명 중 11%가 남성 기준으로 두 번의 검사에서 혈액이 너무 걸쭉했고(혈액량의 절반 넘게가 적혈구), 3.7%와 0.5%가 더 높은 기준을 넘었습니다.
  • 24%는 적어도 한 번의 혈액 검사가 남성 기준을 넘었습니다.
  • 평균적으로 혈액 중 적혈구 비율은 치료 전 39%에서 1년 후 45%로 올랐고, 이후 20년에 걸쳐서는 약간만 올랐습니다.
  • 시작 자료가 있는 776명 중 남성 기준을 넘을 확률은 10년 후 38%, 14년 후 50%에 이르렀습니다.
  • 지속형 테스토스테론 주사는 젤에 비해 혈액이 너무 걸쭉할 오즈가 약 3배와 관련이 있었고, 흡연(오즈 약 두 배), 높은 체중, 높은 시작 나이, 폐 질환도 위험을 높였습니다.
  • 저자들은 게재된 서신에 대한 답변에서, 대신 여성의 정상 기준을 썼다면 두 번의 검사에서 26%가 해당했을 것이라고 말했습니다.
  • 이 연구는 혈전이나 심장마비 같은 실제 건강 사건이 아니라 혈액 검사만 측정했습니다.

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.