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內分泌學會自己的回顧發現，關於荷爾蒙心臟風險的證據只有低品質，且研究的事件很少

跨性別者的性類固醇與心血管結果：系統性回顧與統合分析

系統性與證據審查跨性激素治療
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

  • 這項回顧由內分泌學會出資，以支持其 2017 年關於以荷爾蒙治療性別焦慮（對自己的性別感到痛苦）的指引。
  • 它納入 29 項研究，涵蓋 3,231 名跨性別女性和 1,500 名跨性別男性；只有 1 項隨機分配治療，17 項只比較了人們治療前後，只有 4 項有對照組。
  • 在跨性別男性中，2 年或更久之後，睪固酮與較高的血脂（三酸甘油酯，上升 21.4 mg/dL）、較高的「壞」膽固醇（上升 17.8 mg/dL）和較低的「好」膽固醇（最多下降 8.5 mg/dL）有關。
  • 在跨性別女性中，2 年或更久之後血脂較高（上升 31.9 mg/dL），膽固醇沒有明顯變化。
  • 在跨性別女性中，研究回報 1,767 人中有 56 例血栓、1,073 人中有 14 例心臟病發作、859 人中有 8 例中風，以及 1,486 人中有 139 例死亡，包括 23 例與心臟有關的死亡和 26 例自殺。
  • 在跨性別男性中，研究只回報 771 人中有 1 例血栓、478 人中有 1 例心臟病發作、340 人中沒有中風，以及 651 人中有 13 例死亡。
  • 回顧者將整體證據評為低品質，可能受選擇性報告影響，且對患者最重要的健康事件的資料很少。

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.