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Testosteronas didino raudonųjų kraujo kūnelių kiekį translyčių vyrų: 38 % per 10 metų peržengė vyrišką ribą

Eritrocitozė didelėje testosteroną vartojančių translyčių vyrų kohortoje: ilgalaikis tolesnio stebėjimo tyrimas apie paplitimą, lemiančius veiksnius ir poveikio metus

Kohortiniai ir registro tyrimaiPriešingos lyties hormonai
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

  • Iš 1 073 trans vyrų, vartojančių testosteroną, 11 % turėjo per tirštą kraują (daugiau nei pusę kraujo tūrio sudaro raudonieji kūneliai) dviejuose tyrimuose pagal vyrų standartus; 3,7 % ir 0,5 % peržengė aukštesnes ribas.
  • 24 % turėjo bent vieną kraujo tyrimą virš vyrų ribos.
  • Vidutiniškai raudonųjų kūnelių dalis kraujyje išaugo nuo 39 % prieš gydymą iki 45 % po vienerių metų, o per 20 metų padidėjo tik šiek tiek.
  • Tarp 776 vyrų su pradžios duomenimis tikimybė kada nors viršyti vyrų ribą pasiekė 38 % po 10 metų ir 50 % po 14 metų.
  • Ilgai veikiančios testosterono injekcijos buvo susijusios su maždaug 3 kartus didesniais per tiršto kraujo šansais, palyginti su geliu; rūkymas (maždaug dvigubi šansai), didesnis svoris, vyresnis pradžios amžius ir plaučių ligos taip pat didino riziką.
  • Naudojant įprastą moterų ribą, 26 % būtų atitikę dviejų tyrimų kriterijus, teigė autoriai atsakyme į paskelbtą laišką.
  • Tyrimas matavo tik kraujo tyrimus, o ne realius sveikatos įvykius, tokius kaip kraujo krešuliai ar širdies priepuoliai.

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.