Endocr Pract. 2018 Feb;24(2):135-142. doi: 10.4158/EP-2017-0116. Epub 2017 Nov 16.
Most transgender women depend on medical treatment alone to lower testosterone levels in order to align physical appearance with gender identity. The medical regimen in the United States typically includes spironolactone and estrogens. The purpose of this cross-sectional study was to assess the testosterone suppression achieved among transgender women treated with spironolactone and estrogens.
Testosterone and estradiol levels were extracted from the electronic medical records of 98 anonymized transgender women treated with oral spironolactone and oral estrogen therapy at the Endocrinology Clinic at Boston Medical Center.
Patients starting therapy required about 9 months to reach a steady-state testosterone, with significant heterogeneity of levels achieved among patients. Patients with normal body mass index (BMI) had higher testosterone levels, whereas patients with obese BMI had lower testosterone levels throughout treatment. Stratification of patients by age or spironolactone dosage revealed no significant difference in testosterone levels achieved. At steady state, patients in the highest suppressing quartile were able to achieve testosterone levels of 27 ng/dL, with a standard deviation of 21 ng/dL. Measured serum estradiol levels did not change over time and did not correlate with dosage of estradiol administered.
Among a cohort of transgender women treated with spironolactone and estrogen, the highest suppressing quartile could reliably achieve testosterone levels in the female range at virtually all times. The second highest suppressing quartile could not achieve female levels but remained below the male range virtually all of the time. One quartile was unable to achieve any significant suppression.
BMC = Boston Medical Center BMI = body mass index CPY = cyproterone acetate LC-MS/MS = liquid chromatography-tandem mass spectrometry Q = quartile.
大多数跨性别女性依赖于单纯的医学治疗来降低睾酮水平，以使生理外貌与性别认同一致。美国的医学方案通常包括螺内酯和雌激素。本横断面研究的目的是评估接受螺内酯和雌激素治疗的跨性别女性的睾酮抑制情况。
从波士顿医疗中心内分泌诊所接受口服螺内酯和口服雌激素治疗的 98 名匿名跨性别女性的电子病历中提取睾酮和雌二醇水平。
开始治疗的患者大约需要 9 个月才能达到稳定的睾酮水平，且患者之间的水平存在显著异质性。正常体重指数（BMI）的患者睾酮水平较高，而肥胖 BMI 的患者在整个治疗过程中睾酮水平较低。按年龄或螺内酯剂量分层，患者的睾酮水平无显著差异。在稳定状态下，抑制作用最强的四分位数患者能够达到 27ng/dL 的睾酮水平，标准差为 21ng/dL。测量的血清雌二醇水平随时间无变化，且与给予的雌二醇剂量无关。
在接受螺内酯和雌激素治疗的跨性别女性队列中，抑制作用最强的四分位数几乎可以在所有时间可靠地达到女性范围内的睾酮水平。抑制作用第二强的四分位数无法达到女性水平，但几乎所有时间都保持在男性范围内。有一个四分位数无法实现任何显著的抑制作用。
BMC = 波士顿医疗中心 BMI = 体重指数 CPY = 环丙孕酮 LC-MS/MS = 液相色谱-串联质谱 Q = 四分位数。
