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Testosteron je pri trans moških dvignil rdeče krvničke: 38 % jih je v 10 letih preseglo moški prag eritrocitoze

Eritrocitoza v veliki kohorti trans moških, ki uporabljajo testosteron: dolgoročna nadaljnja študija o pojavnosti, določilnicah in letih izpostavljenosti

Kohortne & registerne študijeKrižni spolni hormoni
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

  • Od 1.073 trans moških na testosteronu je imelo 11 % preveč gosto kri (več kot polovica volumna krvi iz rdečih celic) pri dveh preiskavah po moških standardih; 3,7 % in 0,5 % je preseglo višje meje.
  • 24 % jih je imelo vsaj eno krvno preiskavo nad moško mejo.
  • V povprečju se je delež krvi iz rdečih celic povečal z 39 % pred zdravljenjem na 45 % po enem letu, nato pa se je v 20 letih povečal le nekoliko.
  • Med 776 moškimi z začetnimi podatki je verjetnost, da kdaj presežejo moško mejo, po 10 letih dosegla 38 % in po 14 letih 50 %.
  • Dolgodelujoče injekcije testosterona so bile povezane s približno 3-krat večjimi obeti za preveč gosto kri v primerjavi z gelom; kajenje (približno dvakrat večji obeti), višja teža, višja starost ob začetku in pljučna stanja so tveganje prav tako povečali.
  • Če bi namesto tega uporabili običajno mejo za ženske, bi jih 26 % ustrezalo pri dveh preiskavah, so avtorji povedali v odgovoru na objavljeno pismo.
  • Študija je merila samo krvne preiskave, ne pa dejanskih zdravstvenih dogodkov, kot so krvni strdki ali srčni infarkti.

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.