Institute of Reproductive and Regenerative Medicine, Center of Reproductive Medicine and Andrology, Muenster, Germany; Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, Muenster, Germany.
Institute of Reproductive and Regenerative Medicine, Center of Reproductive Medicine and Andrology, Muenster, Germany.
J Sex Med. 2021 Oct;18(10):1807-1817. doi: 10.1016/j.jsxm.2021.08.004.
Little information is available on steroid hormone profiles in transwomen on the day of gender affirming surgery (GAS) after gender affirming hormone therapy (GAHT).
We compared extended serum steroid hormone profiles of 77 transwomen with 3 different treatment regimens in order to get more insight on how GAHT changes the hormone system.
Samples were obtained from 3 independent clinics. Individuals in clinic A (n = 13) and B (n = 51) discontinued GAHT 4-6 weeks and 2 weeks before GAS, individuals in clinic C (n = 13) continued treatment. Testicular tissue, blood samples and questionnaires on age, weight, height, and medication use were received from each patient. Steroid hormones were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), 6 sex hormones were determined by immunofluorometric assays, and ELISA. Spermatogenesis was scored using the Bergman/Kliesch score.
Participants were not different with regard to age, BMI, treatment duration, and dosage. Feminized blood serum levels with low LH, low FSH and low testosterone, however, were achieved in persons taking GAHT until GAS. Significantly reduced cortisone levels were seen after stopping GAHT before GAS.
GAHT had marked effects on the sex-steroid profile in each person. Factor analysis provided a model explaining 78% of the variance and interdependency of sex steroid levels. Stopping treatment was inversely associated with intactness of the corticosteroid-axis with adrenal steroidogenesis as well as it was inversely associated with pituitary-gonadal hormone production.
Transwomen generally did not have elevated cortisone levels but differed significantly depending on and when GAHT was stopped.
STRENGTHS & LIMITATIONS: This is the first study examining the steroid hormone profiles of transgender persons on the day of GAS in a multi-center setting. Additional studies (including follow ups before and after GAS and stress questionnaires) will be necessary to assess these conflicting results about the possible psychological impact on persons undergoing GAS to improve care.
Concerning feminized blood serum levels, continued GAHT seems the better alternative, however stopping treatment 4-6 weeks prior to surgery was associated with reduced cortisone levels. Schneider F, Wistuba J, Holterhus P-M, et al. New Insights Into Extended Steroid Hormone Profiles in Transwomen in a Multi-Center Setting in Germany. J Sex Med 2021;18:1807-1817.
在接受性别肯定激素治疗（GAHT）后进行性别肯定手术（GAS）的当天，关于跨性别女性的类固醇激素谱的信息很少。
我们比较了 77 名接受 3 种不同治疗方案的跨性别女性的扩展血清类固醇激素谱，以更深入地了解 GAHT 如何改变激素系统。
样本来自 3 个独立的诊所。诊所 A（n=13）和 B（n=51）的个体在 GAS 前 4-6 周和 2 周停止 GAHT，诊所 C（n=13）的个体继续治疗。每位患者都收到了睾丸组织、血样和关于年龄、体重、身高和用药的问卷。类固醇激素通过液相色谱-串联质谱法（LC-MS/MS）进行测量，6 种性激素通过免疫荧光测定法和 ELISA 进行测定。使用 Bergman/Kliesch 评分对精子发生进行评分。
参与者在年龄、BMI、治疗持续时间和剂量方面没有差异。然而，在接受 GAHT 直到 GAS 的人中，实现了血清水平的雌性化，表现为 LH、FSH 和睾酮水平低。在 GAS 前停止 GAHT 后，皮质醇水平显著降低。
GAHT 对每个人的性激素谱都有显著影响。因子分析提供了一个解释 78%方差和性激素水平相互依赖性的模型。停止治疗与皮质类固醇轴的完整性呈负相关，与肾上腺类固醇生成以及垂体-性腺激素产生呈负相关。
跨性别女性的皮质醇水平一般不会升高，但根据 GAHT 的停止时间，差异显著。
这是第一项在多中心环境中研究跨性别者在 GAS 当天类固醇激素谱的研究。为了评估接受 GAS 的人可能产生的心理影响，还需要进行额外的研究（包括 GAS 前后的随访和压力问卷），以改善护理。
就雌性化的血清水平而言，继续 GAHT 似乎是更好的选择，然而，在手术前 4-6 周停止治疗与皮质醇水平降低有关。Schneider F, Wistuba J, Holterhus P-M, et al. New Insights Into Extended Steroid Hormone Profiles in Transwomen in a Multi-Center Setting in Germany. J Sex Med 2021;18:1807-1817.
