奥地利跨性别者队列中，性别确认激素疗法对心血管危险因素的影响，重点关注葡萄糖代谢。
Effects of gender-affirming hormone therapy on cardiovascular risk factors focusing on glucose metabolism in an Austrian transgender cohort.
作者信息
Deischinger Carola, Slukova Dorota, Just Ivica, Kaufmann Ulrike, Harreiter Juergen, van Trotsenburg Mick, Trattnig Siegfried, Krššák Martin, Kautzky-Willer Alexandra, Klepochova Radka, Kosi-Trebotic Lana
机构信息
Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
High field MR Centre of Excellence, Department of Biomedical Imaging and Image guided Therapy, Medical University of Vienna, Vienna, Austria.
出版信息
Int J Transgend Health. 2022 Oct 8;24(4):499-509. doi: 10.1080/26895269.2022.2123425. eCollection 2023.
OBJECTIVE
We aimed to investigate the effect of gender-affirming hormone therapy (GAHT) on cardiovascular disease risk factors focusing on glucose tolerance.
PATIENTS AND METHODS
This primarily translational study enrolled 16 transgender persons assigned female at birth (AFAB), 22 assigned male at birth (AMAB), and 33 age- and BMI-matched cisgender controls at the Medical University of Vienna from 2013 to 2020. A 3-Tesla MRI scan to measure intramyocardial, pancreatic, hepatic fat content and subcutaneous-to-visceral adipose tissue ratio (SAT/VAT-ratio), an oral glucose tolerance test (oGTT), bloodwork including brain natriuretic peptide (pro-BNP), sex hormones and two glucose-metabolism related biomarkers (adiponectin, betatrophin) were performed.
RESULTS
Estrogen intake was associated with higher fasting insulin (p = 0.034) and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (p = 0.037), however, lower HbA1c levels (p = 0.031) in AMAB than cisgender males. Adiponectin (p = 0.001) and betatrophin (p = 0.034) levels were higher in AMAB than cisgender males, but similar to cisgender females. Compared to cisgender females, AFAB displayed no differences in glucose metabolism or SAT/VAT-ratio. AFAB had lower pro-BNP levels (p = 0.014), higher liver enzymes (AST: p = 0.011; ALT: p = 0.012) and lower HDL levels (p = 0.017) than cisgender females, but comparable levels to cisgender males. AMAB showed an increased heart rate (p < 0.001) and pro-BNP (p = 0.002) levels, but a more favorable SAT/VAT-ratio (p = 0.013) and lower creatine kinase (CK) (p = 0.001) than cisgender males. There were no relevant differences in organ fat content between transgender persons and their respective cisgender controls.
CONCLUSION
In AMAB, most investigated parameters adapted to levels seen in cisgender females except for parameters related to fasted insulin resistance. AMAB should be monitored with respect to the development of insulin resistance.
目的
我们旨在研究性别肯定激素疗法（GAHT）对以葡萄糖耐量为重点的心血管疾病风险因素的影响。
患者与方法
这项主要的转化研究于2013年至2020年在维也纳医科大学招募了16名出生时被指定为女性的跨性别者（AFAB）、22名出生时被指定为男性的跨性别者（AMAB）以及33名年龄和体重指数相匹配的顺性别对照者。进行了3特斯拉磁共振成像扫描以测量心肌内、胰腺、肝脏脂肪含量以及皮下与内脏脂肪组织比率（SAT/VAT比率），口服葡萄糖耐量试验（oGTT），血液检测包括脑钠肽（pro-BNP）、性激素以及两种与葡萄糖代谢相关的生物标志物（脂联素、β细胞营养因子）。
结果
在AMAB中，雌激素摄入与较高的空腹胰岛素水平（p = 0.034）和胰岛素抵抗稳态模型评估（HOMA-IR）（p = 0.037）相关，但糖化血红蛋白水平较低（p = 0.031），与顺性别男性相比。AMAB中的脂联素（p = 0.001）和β细胞营养因子（p = 0.034）水平高于顺性别男性，但与顺性别女性相似。与顺性别女性相比，AFAB在葡萄糖代谢或SAT/VAT比率方面无差异。AFAB的pro-BNP水平较低（p = 0.014），肝酶较高（AST：p = 0.011；ALT：p = 0.012），高密度脂蛋白水平较低（p = 0.017），与顺性别女性相比，但与顺性别男性相当。AMAB的心率（p < 0.001）和pro-BNP水平（p = 0.002）升高，但SAT/VAT比率更有利（p = 0.013），肌酸激酶（CK）较低（p = 0.001），与顺性别男性相比。跨性别者与其各自的顺性别对照者之间的器官脂肪含量无相关差异。
结论
在AMAB中，除了与空腹胰岛素抵抗相关的参数外，大多数研究参数适应于顺性别女性所见水平。应监测AMAB胰岛素抵抗的发展情况。
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