Milionis Charalampos, Ilias Ioannis, Koukkou Eftychia
Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece.
World J Clin Cases. 2023 Jan 16;11(2):299-307. doi: 10.12998/wjcc.v11.i2.299.
Transgender persons constitute a non-negligible percentage of the general population. Physical gender-transitioning in trans persons is mainly achieved with hormonal cross-sex therapy and sex reassignment surgeries that aim to align bodily appearance with gender identity. Hormonal treatment acts via suppressing the secretion of the endogenous sex hormones and replacing them with the hormones of the desired sex. The administration of testosterone is the typical masculinizing treatment in trans men, whilst trans women are routinely treated with estradiol agents in combination with anti-androgens or gonadotrophin-releasing hormone agonists if testes are present. Exogenous androgenic steroids, estradiol agents, and anti-androgens have been implicated in a series of hepatotoxic effects. Thus, liver integrity is a major concern with the long-term administration of cross-sex therapy. Hepatic tissue is susceptible to coronavirus disease 19 (COVID-19) through various pathophysiological mechanisms. Special consideration should be paid to minimize the risk of hepatic damage from the potential cumulative effect of COVID-19 and gender-affirming treatment in transgender patients. Appropriate care is significant, with continuous laboratory monitoring, clinical observation and, if needed, specific treatment, especially in severe cases of infection and in persons with additional liver pathologies. The pandemic can be an opportunity to provide equal access to care for all and increase the resilience of the transgender population.
跨性别者在总人口中占比不可忽视。跨性别者的身体性别转变主要通过激素跨性别治疗和性别重置手术来实现，这些治疗旨在使身体外观与性别认同相一致。激素治疗通过抑制内源性性激素的分泌，并以所需性别的激素取而代之来发挥作用。睾酮给药是跨性别男性典型的男性化治疗方法，而对于有睾丸的跨性别女性，常规会使用雌二醇制剂联合抗雄激素或促性腺激素释放激素激动剂进行治疗。外源性雄激素类固醇、雌二醇制剂和抗雄激素已被证实与一系列肝毒性作用有关。因此，长期进行跨性别治疗时，肝脏完整性是一个主要关注点。肝组织通过多种病理生理机制易感染冠状病毒病（COVID-19）。应特别考虑将COVID-19与性别确认治疗的潜在累积效应导致肝损伤的风险降至最低。适当的护理非常重要，包括持续的实验室监测、临床观察，必要时进行特定治疗，尤其是在严重感染病例和有其他肝脏病变的人群中。这场大流行可以成为为所有人提供平等医疗服务机会并增强跨性别群体恢复力的契机。
