Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
J Sex Med. 2014 Aug;11(8):1999-2011. doi: 10.1111/jsm.12571. Epub 2014 May 14.
Data on the effects of cross-sex hormone therapy (CHT) are limited due to the low prevalence of gender dysphoria, small number of subjects treated at each center, lack of prospective studies, and wide variations in treatment modalities.
The aim of this study is to report the short-term effects of CHT on hormonal and clinical changes, side effects, and adverse events in trans men (female-to-male gender dysphoric persons) and trans women (male-to-female gender dysphoric persons).
This was a multicenter 1-year prospective study in 53 trans men and 53 trans women. Trans men received injections of testosterone undecanoate every 3 months. Trans women younger than 45 years received 50 mg cyproterone acetate (CA) and 4 mg estradiol valerate daily, whereas those older than 45 years received 50 mg CA daily together with 100 μg/24 hours transdermal 17-β estradiol.
Sex steroids, prolactin, liver enzymes, lipids, hematocrit, blood pressure, anthropometrics, Ferriman and Gallwey score, and global acne grading scale were measured. Side effects, adverse events, and desired clinical changes were examined.
No deaths or severe adverse events were observed. Two trans men developed erythrocytosis, and two had transient elevation of the liver enzymes. Trans men reported an increase in sexual desire, voice instability, and clitoral pain (all P ≤ 0.01). Testosterone therapy increased acne scores, facial and body hair, and prevalence of androgenetic alopecia. Waist-hip ratio, muscle mass, triglycerides, total cholesterol (C), and LDL-C increased, whereas total body fat mass and HDL-C decreased. Three trans women experienced transient elevation of liver enzymes. A significant increase in breast tenderness, hot flashes, emotionality, and low sex drive was observed (all P ≤ 0.02). Fasting insulin, total body fat mass, and prolactin levels increased, and waist-hip ratio, lean mass, total C, and LDL-C decreased.
Current treatment modalities were effective and carried a low risk for side effects and adverse events at short-time follow-up.
由于性别焦虑症的患病率较低、每个中心治疗的受试者人数较少、缺乏前瞻性研究以及治疗方式差异较大，因此有关跨性别激素治疗（CHT）效果的数据有限。
本研究旨在报告短期 CHT 对跨性别男性（女性性别焦虑症患者）和跨性别女性（男性性别焦虑症患者）的激素和临床变化、副作用和不良事件的影响。
这是一项在 53 名跨性别男性和 53 名跨性别女性中进行的多中心为期 1 年的前瞻性研究。跨性别男性每 3 个月接受一次十一酸睾酮注射液治疗。年龄小于 45 岁的跨性别女性每天接受 50 毫克环丙孕酮和 4 毫克戊酸雌二醇治疗，而年龄大于 45 岁的跨性别女性每天接受 50 毫克环丙孕酮和 100 微克/24 小时经皮 17-β雌二醇治疗。
检测性激素、催乳素、肝酶、血脂、红细胞压积、血压、人体测量学、Ferriman 和 Gallwey 评分和全球痤疮分级量表。检查副作用、不良事件和所需的临床变化。
未观察到死亡或严重不良事件。两名跨性别男性出现红细胞增多症，两名男性的肝酶一过性升高。跨性别男性报告性欲增加、声音不稳定和阴蒂疼痛（均 P ≤ 0.01）。睾丸激素治疗增加了痤疮评分、面部和身体毛发以及雄激素性脱发的发生率。腰臀比、肌肉量、甘油三酯、总胆固醇（C）和 LDL-C 增加，而总体脂量和 HDL-C 减少。三名跨性别女性出现肝酶一过性升高。观察到乳房触痛、热潮红、情绪和性欲下降显著增加（均 P ≤ 0.02）。空腹胰岛素、总体脂量和催乳素水平增加，腰臀比、瘦体重、总 C 和 LDL-C 减少。
在短期随访中，目前的治疗方法有效且副作用和不良事件风险较低。
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