Bretherton Ingrid, Spanos Cassandra, Leemaqz Shalem Y, Premaratne Gehan, Grossmann Mathis, Zajac Jeffrey D, Cheung Ada S
Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, South Australia.
Ther Adv Endocrinol Metab. 2021 Jan 23;12:2042018820985681. doi: 10.1177/2042018820985681. eCollection 2021.
Transgender individuals receiving gender-affirming hormone therapy (GAHT) are at increased risk of adverse cardiovascular outcomes. This may be related to effects on body composition and insulin resistance.
To examine relationships between body fat distribution and insulin resistance in transgender individuals on established GAHT.
Comparisons of body composition (dual energy X-ray absorptiometry) and insulin resistance [Homeostasis Model of Insulin Resistance (HOMA2-IR)] were made between transgender individuals (43 trans men and 41 trans women) on established GAHT (>12 months) and age-matched cisgender controls (30 males and 48 females). Multiple linear regressions were used to examine the relationship between HOMA2-IR and fat mass with gender, adjusting for age and total duration of GAHT and Pearson correlation coefficients are reported.
Compared with control cisgender women, trans men had mean difference of +7.8 kg (4.0, 11.5), < 0.001 in lean mass and higher android:gynoid fat ratio [0.2 (0.1, 0.3), < 0.001], but no difference in overall fat mass or insulin resistance. Compared with control cisgender men, trans women had median difference in lean mass of -6.9 kg (-10.6, -3.1), < 0.001, fat mass of +9.8 kg (3.9, 14.5), = 0.001, lower android:gynoid fat ratio -0.1 (-0.2,-0.0), < 0.05), and higher insulin resistance 1.6 (1.3-1.9), < 0.001). Higher HOMA2-IR correlated with higher android ( = 0.712, < 0.001) and gynoid ( = 0.572, < 0.001) fat mass in both trans men and trans women.
Android fat more strongly correlates with insulin resistance than gynoid fat in transgender individuals. Higher fat mass and insulin resistance in trans women may predispose to increased cardiovascular risk. Despite adverse fat distribution, insulin resistance was not higher in trans men.
接受性别确认激素疗法（GAHT）的跨性别者出现不良心血管结局的风险增加。这可能与对身体成分和胰岛素抵抗的影响有关。
研究接受既定GAHT的跨性别者体内脂肪分布与胰岛素抵抗之间的关系。
对接受既定GAHT（>12个月）的跨性别者（43名跨性别男性和41名跨性别女性）与年龄匹配的顺性别对照者（30名男性和48名女性）进行身体成分（双能X线吸收法）和胰岛素抵抗[胰岛素抵抗稳态模型（HOMA2-IR）]的比较。使用多元线性回归分析HOMA2-IR与脂肪量之间的关系，并根据性别、年龄和GAHT总疗程进行调整，报告Pearson相关系数。
与对照顺性别女性相比，跨性别男性的瘦体重平均差异为+7.8 kg（4.0，11.5），P<0.001，且android:gynoid脂肪比率更高[0.2（0.1，0.3），P<0.001]，但总体脂肪量或胰岛素抵抗无差异。与对照顺性别男性相比，跨性别女性的瘦体重中位数差异为-6.9 kg（-10.6，-3.1），P<0.001，脂肪量差异为+9.8 kg（3.9，14.5），P=0.001，android:gynoid脂肪比率更低-0.1（-0.2，-0.0），P<0.05），胰岛素抵抗更高1.6（1.3-1.9），P<0.001）。在跨性别男性和跨性别女性中，较高的HOMA2-IR与较高的android（P=0.712，P<0.001）和gynoid（P=0.572，P<0.001）脂肪量相关。
在跨性别者中，android脂肪比gynoid脂肪与胰岛素抵抗的相关性更强。跨性别女性较高的脂肪量和胰岛素抵抗可能易导致心血管风险增加。尽管脂肪分布不利，但跨性别男性的胰岛素抵抗并不更高。
