Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Endocrine. 2020 Apr;68(1):6-15. doi: 10.1007/s12020-020-02197-5. Epub 2020 Feb 17.
Hormone replacement therapy (HRT) has become a mainstay medical treatment option for management of gender dysphoria in transgender patients of both biologic sexes. Very little is known about the long-term effects of steroid hormone modulation on breast tissue in this population. Most of the data available on the effects of HRT on breast and reproductive tissues come from studies of postmenopausal cisgender women. Therapeutic regimens are often provider-dependent, and there, are no uniform guidelines in place for cancer surveillance in transgender patients. In this review, we present what forms of hormone therapy and hormone modulation are available to transgender patients, what is known about their effects on male and female breast tissue, and what other endogenous and exogenous factors contribute to the macroscopic and cellular changes observed.
A search for the existing literature focusing on therapeutic regimens and the effects of HRT on breast tissue provided the most current information available for this review. Recent evidence-based reports (since the year 2000) and reviews were given priority over anecdotal evidence and expert opinions when conflicting information was encountered. Older resources were considered when primary sources were needed. Given the paucity of available articles on this subject, all resources were given careful consideration.
Information about the risks associated with HRT in the current literature and in this setting is limited and often conflicting, due to a scarcity of long-term studies tracking breast pathology among transgender men and women.
We conclude that the long-term effects of off-label pharmaceutical use for modulation of hormone levels and sexual characteristics in transgender patients have not been well studied. The tendency of steroid hormones to promote the growth of certain cancers also raises questions about the safety of differing doses and drug combinations. Further clinical and laboratory study is needed to better establish safety and dosing guidelines in transgender patients.
激素替代疗法（HRT）已成为跨性别患者性别焦虑管理的主要医学治疗选择，无论其生物学性别如何。关于这种人群中甾体激素调节对乳腺组织的长期影响，知之甚少。关于 HRT 对乳腺和生殖组织影响的大多数可用数据来自绝经后顺性别女性的研究。治疗方案通常依赖于提供者，并且针对跨性别患者的癌症监测没有统一的指南。在这篇综述中，我们介绍了可供跨性别患者使用的激素治疗和激素调节形式，以及它们对男性和女性乳腺组织的已知影响，以及其他内源性和外源性因素如何导致观察到的宏观和细胞变化。
搜索了重点关注治疗方案和 HRT 对乳腺组织影响的现有文献，为本次综述提供了最新的可用信息。在遇到相互矛盾的信息时，优先考虑最近的基于证据的报告（自 2000 年以来）和综述，而不是轶事证据和专家意见。当需要主要来源时，会考虑使用较旧的资源。鉴于关于这个主题的可用文章很少，所有资源都经过了仔细考虑。
由于缺乏长期跟踪跨性别男性和女性乳腺病理学的研究，目前文献和这一背景下与 HRT 相关的风险信息有限且经常相互矛盾。
我们得出结论，尚未对跨性别患者用于调节激素水平和性特征的标签外药物使用的长期影响进行充分研究。甾体激素促进某些癌症生长的趋势也引发了关于不同剂量和药物组合安全性的问题。需要进一步的临床和实验室研究，以更好地确定跨性别患者的安全性和剂量指南。
