Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, Georgia.
Endocr Pract. 2021 Jan;27(1):27-33. doi: 10.4158/EP-2020-0414. Epub 2020 Nov 18.
To examine the association of various gender-affirming hormone therapy regimens with blood sex hormone concentrations in transgender individuals.
This retrospective study included transgender people receiving gender-affirming hormone therapy between January 2000 and September 2018. Data on patient demographics, laboratory values, and hormone dose and frequency were collected. Nonparametric tests and linear regression analyses were used to identify factors associated with serum hormone concentrations.
Overall, 196 subjects (134 transgender women and 62 transgender men), with a total of 941 clinical visits, were included in this study. Transgender men receiving transdermal testosterone had a significantly lower median concentration of serum total testosterone when compared with those receiving injectable preparations (326.0 ng/dL vs 524.5 ng/dL, respectively, P = .018). Serum total estradiol concentrations in the transgender women were higher in those receiving intramuscular estrogen compared with those receiving oral and transdermal estrogen (366.0 pg/mL vs 102.0 pg/mL vs 70.8 pg/mL, respectively, P < .001). A dose-dependent increase in the hormone levels was observed for oral estradiol (P < .001) and injectable testosterone (P = .018) but not for intramuscular and transdermal estradiol. Older age and a history of gonadectomy in both the transgender men and women were associated with significantly higher concentrations of serum gender-affirming sex hormones.
In the transgender men, all routes and formulations of testosterone appeared to be equally effective in achieving concentrations in the male range. The intramuscular injections of estradiol resulted in the highest serum concentrations of estradiol, whereas transdermal estradiol resulted in the lowest concentration. There was positive relationship between both oral estradiol and injectable testosterone dose and serum sex hormone concentrations in transgender people receiving GAHT.
研究各种性别肯定激素治疗方案与跨性别个体血液性激素浓度的关系。
本回顾性研究纳入了 2000 年 1 月至 2018 年 9 月期间接受性别肯定激素治疗的跨性别者。收集了患者的人口统计学数据、实验室值以及激素剂量和频率。采用非参数检验和线性回归分析来确定与血清激素浓度相关的因素。
本研究共纳入 196 名受试者（134 名跨性别女性和 62 名跨性别男性），共 941 次就诊。与接受注射制剂的患者相比，接受透皮睾酮治疗的跨性别男性的血清总睾酮浓度显著更低（分别为 326.0ng/dL 和 524.5ng/dL，P=.018）。与接受口服和透皮雌激素的患者相比，接受肌肉内雌激素治疗的跨性别女性的血清总雌二醇浓度更高（分别为 366.0pg/mL、102.0pg/mL 和 70.8pg/mL，P<.001）。口服雌二醇（P<.001）和注射睾酮（P=.018）的剂量依赖性增加，但肌肉内和透皮雌二醇则没有。在跨性别男性和女性中，年龄较大和性腺切除术史与血清性别肯定性激素浓度显著升高相关。
在跨性别男性中，所有途径和制剂的睾酮似乎都能同样有效地达到男性范围内的浓度。肌肉内注射雌二醇可导致血清雌二醇浓度最高，而透皮雌二醇则导致浓度最低。接受 GAHT 的跨性别者中，口服雌二醇和注射睾酮剂量与血清性激素浓度之间存在正相关关系。
