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Pačios Endokrinologų draugijos apžvalga rado tik žemos kokybės įrodymų apie hormonų riziką širdžiai, mažai įvykių

Lytiniai steroidai ir širdies bei kraujagyslių rezultatai translyčių asmenų tarpe: sisteminė apžvalga ir metaanalizė

Sisteminės ir įrodymų apžvalgosPriešingos lyties hormonai
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

  • Apžvalgą apmokėjo Endokrinologų draugija, kad paremtų savo 2017 m. gaires dėl genderinės disforijos (distreso dėl savo lyties) gydymo hormonais.
  • Įtraukta 29 tyrimai, apėmę 3 231 trans moterį ir 1 500 trans vyrų; tik 1 atsitiktinai paskyrė gydymą, 17 tik lygino žmones prieš ir po, o tik 4 turėjo palyginamąją grupę.
  • Trans vyrams po 2 ar daugiau metų testosteronas buvo susijęs su didesniais kraujo riebalais (trigliceridai, padidėjo 21,4 mg/dL), didesniu „bloguoju“ cholesteroliu (padidėjo 17,8 mg/dL) ir mažesniu „gerojo“ cholesterolio kiekiu (sumažėjo iki 8,5 mg/dL).
  • Trans moterims kraujo riebalai buvo didesni po 2 ar daugiau metų (padidėjo 31,9 mg/dL), be aiškaus cholesterolio pokyčio.
  • Tarp trans moterų tyrimai pranešė apie 56 kraujo krešulius 1 767 žmonėms, 14 širdies priepuolių 1 073, 8 insultus 859 ir 139 mirtis 1 486, įskaitant 23 su širdimi susijusias mirtis ir 26 savižudybes.
  • Tarp trans vyrų tyrimai pranešė tik apie 1 kraujo krešulį 771, 1 širdies priepuolį 478, jokių insultų 340 ir 13 mirčių 651.
  • Apžvalgininkai bendrus įrodymus įvertino kaip žemos kokybės, tikėtinai paveiktus selektyvaus pateikimo, su mažai duomenų apie sveikatos įvykius, kurie pacientams svarbiausi.

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.