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Endocrine Societys egen gjennomgang fant bare belegg av lav kvalitet om hormoners hjerterisiko, med få hendelser studert

Kjønnssteroider og kardiovaskulære utfall hos transkjønnede personer: en systematisk oversikt og metaanalyse

Systematiske og evidensoversikterKjønnsbekreftende hormoner
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

  • Gjennomgangen ble betalt av Endocrine Society til støtte for retningslinjen fra 2017 om behandling av kjønnsdysfori (plager over sitt eget kjønn) med hormoner.
  • Den inkluderte 29 studier med 3 231 transkvinner og 1 500 transmenn. Bare 1 fordelte behandling tilfeldig, 17 sammenlignet bare folk før og etter, og bare 4 hadde en sammenligningsgruppe.
  • Hos transmenn var testosteron etter 2 eller flere år knyttet til høyere blodfett (triglyserider, opp 21,4 mg/dL), høyere «dårlig» kolesterol (opp 17,8 mg/dL) og lavere «godt» kolesterol (ned med opptil 8,5 mg/dL).
  • Hos transkvinner var blodfettet høyere etter 2 eller flere år (opp 31,9 mg/dL), uten tydelig endring i kolesterol.
  • Blant transkvinner rapporterte studiene 56 blodpropper hos 1 767 personer, 14 hjerteinfarkt hos 1 073, 8 hjerneslag hos 859 og 139 dødsfall hos 1 486, inkludert 23 hjerterelaterte dødsfall og 26 selvmord.
  • Blant transmenn rapporterte studiene bare 1 blodpropp hos 771, 1 hjerteinfarkt hos 478, ingen hjerneslag hos 340 og 13 dødsfall hos 651.
  • Gjennomgangsforfatterne vurderte den samlede evidensen som av lav kvalitet, trolig påvirket av selektiv rapportering, med lite data om helsehendelsene som betyr mest for pasientene.

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.