Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany.
Division of Pediatric Endocrinology and Diabetes, Department of Pediatric and Adolescent Medicine, University of Lübeck, Lübeck, Germany.
Endocrine. 2022 Jun;76(3):722-732. doi: 10.1007/s12020-022-03017-8. Epub 2022 Mar 8.
To study differences in metabolic outcomes between testosterone and estradiol replacement in probands with complete androgen insensitivity syndrome (CAIS).
In this multicentre, double-blind, randomized crossover trial, 26 women with CAIS were included of whom 17 completed the study. After a two-months run in phase with estradiol, probands either received transdermal estradiol followed by crossover to transdermal testosterone or vice versa. After six months, differences in lipids, fasting glucose, insulin, hematocrit, liver parameters and blood pressure between the treatment phases were investigated.
Linear mixed models adjusted for period and sequence did not reveal major group differences according to treatment for the investigated outcomes. In each treatment group, there were however significant uniform changes in BMI and cholesterol. BMI increased significantly, following six months of estradiol ( + 2.7%; p = 0.036) as well as testosterone treatment ( + 2.8%; p = 0.036). There was also a significant increase in total ( + 10.4%; p = 0.001) and LDL-cholesterol ( + 29.2%; p = 0.049) and a decrease in HDL-cholesterol (-15.8%; p < 0.001) following six months of estradiol as well as six months of testosterone treatment (total cholesterol: + 14.6%; p = 0.008; LDL-cholesterol: + 39.1%; p = 0.005, HDL-cholesterol: -15.8%; p = 0.004). Other parameters remained unchanged.
Transdermal estradiol as well as testosterone treatment in women with CAIS results in worsening in lipid profiles. Given the relatively small sample size, subtle group differences in other metabolic parameters may have remained undetected.
研究完全雄激素不敏感综合征（CAIS）患者中睾酮和雌二醇替代治疗的代谢结果差异。
在这项多中心、双盲、随机交叉试验中，纳入了 26 名 CAIS 女性患者，其中 17 名完成了研究。在雌二醇治疗两个月后，患者要么接受透皮雌二醇治疗，然后交叉到透皮睾酮治疗，要么反之。六个月后，研究比较了治疗阶段之间的血脂、空腹血糖、胰岛素、红细胞压积、肝参数和血压的差异。
线性混合模型调整了周期和顺序，根据治疗方案，对研究结果没有发现主要的组间差异。然而，在每个治疗组中，BMI 和胆固醇都有显著的统一变化。在接受雌二醇治疗 6 个月后（+2.7%；p=0.036）和睾酮治疗 6 个月后（+2.8%；p=0.036），BMI 显著增加。此外，总胆固醇（+10.4%；p=0.001）和 LDL 胆固醇（+29.2%；p=0.049）显著增加，HDL 胆固醇（-15.8%；p<0.001）在接受雌二醇治疗 6 个月后以及接受睾酮治疗 6 个月后也有所下降（总胆固醇：+14.6%；p=0.008；LDL 胆固醇：+39.1%；p=0.005；HDL 胆固醇：-15.8%；p=0.004）。其他参数保持不变。
CAIS 女性患者接受透皮雌二醇和睾酮治疗会导致血脂谱恶化。由于样本量相对较小，其他代谢参数的细微组间差异可能未被发现。
