Maraka Spyridoula, Singh Ospina Naykky, Rodriguez-Gutierrez Rene, Davidge-Pitts Caroline J, Nippoldt Todd B, Prokop Larry J, Murad M Hassan
Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905.
Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205.
J Clin Endocrinol Metab. 2017 Nov 1;102(11):3914-3923. doi: 10.1210/jc.2017-01643.
Transgender individuals receive cross-sex hormonal therapy to induce desired secondary sexual characteristics despite limited data regarding its effects on cardiovascular health.
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).
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).
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.
尽管关于跨性别激素疗法对心血管健康影响的数据有限，但跨性别者仍接受跨性别激素疗法以诱导出期望的第二性征。
截至2015年4月7日，对多个数据库进行了全面检索，以查找评估使用性类固醇对跨性别者血脂、心肌梗死、中风、静脉血栓栓塞（VTE）和死亡率影响的研究。由两名评审员挑选并评估这些研究。采用随机效应模型汇总加权平均差和95%置信区间（CI）。
我们发现了29项偏倚风险为中度的合格研究。在女性向男性转变（FTM）的个体中，性类固醇疗法在3至6个月以及≥24个月时与血清甘油三酯（TG）水平有统计学意义的升高相关（升高21.4mg/dL；95%CI：0.14至42.6），在12个月以及≥24个月时与低密度脂蛋白胆固醇（LDL-C）水平升高相关（升高17.8mg/dL；95%CI：3.5至32.1）。在所有随访期内，高密度脂蛋白胆固醇（HDL-C）水平均显著下降（在≥24个月时下降幅度最大，为-8.5mg/dL；95%CI：-13.0至-3.9）。在男性向女性转变（MTF）的个体中，血清TG水平在≥24个月时显著升高（升高31.9mg/dL；95%CI：3.9至59.9），而其他参数无任何变化。报告的心肌梗死、中风、VTE和死亡事件较少（在MTF个体中更常见）。
低质量证据表明，性类固醇疗法可能会使FTM个体的LDL-C和TG水平升高，HDL-C水平降低，而口服雌激素可能会使MTF个体的TG水平升高。关于重要患者结局的数据仍然很少。
