Department of Endocrinology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Department Metabolic Health Research, The Netherlands Organisation for Applied Scientific Research (TNO), Leiden, The Netherlands.
PLoS One. 2022 Mar 15;17(3):e0261312. doi: 10.1371/journal.pone.0261312. eCollection 2022.
Cardiovascular risk is increased in transgender persons using gender-affirming hormone therapy. To gain insight into the mechanism by which sex hormones affect cardiovascular risk in transgender persons, we investigated the effect of hormone therapy on markers of inflammation and hemostasis.
In this exploratory study, 48 trans women using estradiol patches plus cyproterone acetate (CPA) and 47 trans men using testosterone gel were included. They were between 18 and 50 years old and did not have a history of cardiovascular events. Measurements were performed before and after 3 and 12 months of hormone therapy.
After 12 months, in trans women, systemic and endothelial inflammatory markers decreased (hs-CRP -66%, (95% CI -76; -53), VCAM-1-12%, (95% CI -16; -8)), while platelet activation markers increased (PF-4 +17%, (95% CI 4; 32), β-thromboglobulin +13%, (95% CI 2; 24)). The coagulation marker fibrinogen increased transiently, after 3 months (+15%, (95% CI 1; 32)). In trans men, hs-CRP increased (+71%, (95% CI 19; 145)); platelet activation and coagulation markers were not altered. In both trans women and trans men, leptin and adiponectin changed towards reference values of the experienced gender.
Platelet activation and coagulation marker concentrations increased in trans women using transdermal estradiol plus CPA, but not in trans men using testosterone. Also, concentrations of inflammatory markers decreased in trans women, while hs-CRP increased in trans men. Our results indicate that hormone therapy may affect hemostasis in transgender persons, which could be an underlying mechanism explaining the increased cardiovascular risk in this population.
使用性别肯定激素治疗的跨性别者心血管风险增加。为了深入了解性激素如何影响跨性别者的心血管风险，我们研究了激素治疗对炎症和止血标志物的影响。
在这项探索性研究中，纳入了 48 名使用雌二醇贴片加环丙孕酮（CPA）的跨女性和 47 名使用睾酮凝胶的跨男性。他们年龄在 18 至 50 岁之间，没有心血管事件史。在激素治疗前、后 3 个月和 12 个月进行了测量。
在 12 个月后，在跨女性中，系统和内皮炎症标志物降低（hs-CRP 降低 66%，（95%CI -76；-53），VCAM-1 降低 12%，（95%CI -16；-8）），而血小板活化标志物增加（PF-4 增加 17%，（95%CI 4；32），β-血栓球蛋白增加 13%，（95%CI 2；24））。凝血标志物纤维蛋白原在 3 个月后短暂增加（增加 15%，（95%CI 1；32））。在跨男性中，hs-CRP 增加（增加 71%，（95%CI 19；145））；血小板活化和凝血标志物没有改变。在跨女性和跨男性中，瘦素和脂联素向所经历性别的参考值转变。
使用透皮雌二醇加 CPA 的跨女性血小板活化和凝血标志物浓度增加，但使用睾酮的跨男性则没有。此外，跨女性的炎症标志物浓度降低，而跨男性的 hs-CRP 增加。我们的结果表明，激素治疗可能会影响跨性别者的止血功能，这可能是解释该人群心血管风险增加的潜在机制。
