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内分泌学会自己的综述发现，关于激素心脏风险的证据只有低质量，且研究的事件很少

跨性别者的性类固醇与心血管结局：系统综述与荟萃分析

系统性与证据综述跨性别激素
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

  • 该综述由内分泌学会出资，以支持其2017年关于用激素治疗性别焦虑（对自己的性别感到痛苦）的指南。
  • 它纳入了29项研究，涵盖3,231名跨性别女性和1,500名跨性别男性；只有1项随机分配了治疗，17项只是比较了人们的前后变化，只有4项有对照组。
  • 在跨性别男性中，2年或更久之后，睾酮与较高的血脂（甘油三酯，升高21.4毫克/分升）、较高的“坏”胆固醇（升高17.8毫克/分升）和较低的“好”胆固醇（最多下降8.5毫克/分升）有关。
  • 在跨性别女性中，2年或更久之后血脂较高（升高31.9毫克/分升），胆固醇没有明显变化。
  • 在跨性别女性中，研究报告了1,767人中有56例血栓，1,073人中有14例心脏病发作，859人中有8例中风，1,486人中有139例死亡，其中包括23例心脏相关死亡和26例自杀。
  • 在跨性别男性中，研究只报告了771人中有1例血栓，478人中有1例心脏病发作，340人中没有中风，651人中有13例死亡。
  • 评审者将总体证据评为低质量，可能受到选择性报告的影响，而且关于对患者最重要的健康事件的数据很少。

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.