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内分泌学会综述：使用激素后短期骨密度变化不大，但几乎没有骨折数据

性类固醇对跨性别者骨骼健康的影响：系统综述与荟萃分析

系统性与证据综述跨性别激素
Authors
Naykky Singh-Ospina, Spyridoula Maraka, Rene Rodriguez-Gutierrez, Caroline Davidge-Pitts, Todd B. Nippoldt, Larry J. Prokop, Mohammad Hassan Murad
Journal
The Journal of Clinical Endocrinology & Metabolism
Year
2017
Source
https://doi.org/10.1210/jc.2017-01642

Summary

This review was one of the evidence reviews behind the Endocrine Society's 2017 guideline on treating gender dysphoria (distress about one's sex). The Mayo Clinic team combined 13 studies (639 people, mostly adults) that measured bone density before and after cross-sex hormones. Testosterone in females made no measurable difference to spine or hip bone density over one to two years. Estrogen in males slightly raised spine bone density. Only one study looked at broken bones (none in a year), and only one looked at teenagers given puberty blockers (drugs that pause puberty) and then hormones. That study found males had lower spine bone density at age 22 than before treatment. The authors said the effect on the risk of broken bones is uncertain. The review is reassuring about short-term bone density in adults, but cannot show long-term safety, fracture risk, or safety for teenagers.

Key findings

  • 该综述合并了13项研究，涵盖639人：392人出生时为男性，247人出生时为女性。
  • 在服用睾酮的女性中，一到两年后，下脊柱和髋部的骨密度没有可测量的变化。
  • 在服用雌激素的男性中，下脊柱骨密度在一年后略有上升，两年后又多升了一点。
  • 只有一项针对53名男性和53名女性的研究考察了骨折，12个月内没有发现骨折。
  • 只有一项研究涉及先使用青春期阻断剂然后使用激素的青少年，发现男性在22岁时的脊柱骨密度低于治疗前。
  • 作者说，大部分证据来自有中等程度误导风险的研究，对骨折风险的影响尚不确定。
  • 该综述是为内分泌学会完成的，使用了与其专家共同制定的计划，以支持其2017年的指南。

Abstract

BACKGROUND: The impact of sex steroids on bone health in transgender individuals is unclear.

METHODS: A comprehensive search of several databases to 7 April 2015 was conducted for studies evaluating bone health in transgender individuals receiving sex steroids. Pairs of reviewers selected and appraised studies. A random effects model was used to pool weighted mean differences and 95% confidence intervals (CIs).

RESULTS: Thirteen studies evaluating 639 transgender individuals were identified [392 male-to-female (MTF), 247 female-to-male (FTM)]. In FTM individuals and compared with baseline values before initiation of masculinizing hormone therapy, there was no statistically significant difference in the lumbar spine, femoral neck, or total hip bone mineral density (BMD) when assessed at 12 and 24 months. In MTF individuals and compared with baseline values before initiation of feminizing hormone therapy, there was a statistically significant increase in lumbar spine BMD at 12 months (0.04 g/cm2; 95% CI, 0.03 to 0.06 g/cm2) and 24 months (0.06 g/cm2; 95% CI, 0.04 to 0.08 g/cm2). Fracture rates were evaluated in a single cohort of 53 MTF and 53 FTM individuals, with no events at 12 months. The body of evidence is derived mostly from observational studies at moderate risk of bias.

CONCLUSION: In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.

Conclusion

In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.