Tienforti D, Savignano G, Spagnolo L, Di Giulio F, Baroni M G, Barbonetti A
Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy.
J Endocrinol Invest. 2025 Jan;48(1):161-171. doi: 10.1007/s40618-024-02418-y. Epub 2024 Jun 22.
To assess the effects of testosterone (T)-based gender affirming hormone therapy (GAHT) on liver blood tests (LBTs) in assigned female at birth adults, using a meta-analytic approach.
Prospective and retrospective studies were selected that reported the prevalence of biochemical liver damage (BLD) and LBTs changes during T therapy. Data collected included pre-and-during therapy alanine-aminotransferase (ALT), aspartate-aminotransferase (AST), gamma-glutamyl-transferase (GGT), and alkaline phosphatase (ALP) mean concentration values.
The prevalence of BLD in 14 studies on 1698 subjects was 1% (95% CI 0.00-3.00; I = 14.1%; p = 0.82). In 17 studies on 2758 subjects, GAHT was associated with a statistically (but not clinically) significant increase in AST, GGT and ALP at 12 months and ALT at 3-7 (MD: 1.19 IU/l; 95% CI 0.31, 2.08; I: 0%), at 12 (MD: 2.31 IU/l; 95% CI 1.41, 3.21; I: 29%), but with no more significant increase at 24 months (MD: 1.71 IU/l; 95% CI -0.02, 3.44; I: 0%).
Analysis of aggregate estimates confirms a low risk of BLD and abnormalities in LBTs, transient in most cases, during T-based GAHT, thus suggesting a limited need for careful liver monitoring in AFAB people.
采用荟萃分析方法，评估基于睾酮（T）的性别确认激素疗法（GAHT）对出生时被指定为女性的成年人肝脏血液检查（LBTs）的影响。
选择前瞻性和回顾性研究，这些研究报告了T治疗期间生化肝损伤（BLD）的患病率和LBTs变化。收集的数据包括治疗前和治疗期间的丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰转移酶（GGT）和碱性磷酸酶（ALP）平均浓度值。
14项针对1698名受试者的研究中，BLD的患病率为1%（95%CI 0.00 - 3.00；I = 14.1%；p = 0.82）。在17项针对2758名受试者的研究中，GAHT与12个月时AST、GGT和ALP以及3 - 7个月时ALT的统计学（但非临床）显著升高相关（MD：1.19 IU/l；95%CI 0.31，2.08；I：0%），在12个月时（MD：2.31 IU/l；95%CI 1.41，3.21；I：29%），但在24个月时无更显著升高（MD：1.71 IU/l；95%CI -0.02，3.44；I：0%）。
汇总估计分析证实，在基于T的GAHT期间，BLD和LBTs异常的风险较低，大多数情况下是短暂的，因此表明出生时被指定为女性的人群对肝脏进行仔细监测的需求有限。
