Department of Endocrinology, Odense University Hospital, Odense, Denmark.
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Diabetologia. 2024 Nov;67(11):2393-2403. doi: 10.1007/s00125-024-06212-6. Epub 2024 Jul 3.
Transgender identity is often associated with gender dysphoria and minority stress. Gender-affirming hormone treatment (GAHT) includes masculinising or feminising treatment and is expected to be lifelong in most cases. Sex and sex hormones have a differential effect on metabolism and CVD in cisgender people, and sex hormone replacement in hypogonadism is associated with higher vascular risk, especially in ageing individuals. Using narrative review methods, we present evidence regarding metabolic and cardiovascular outcomes during GAHT and propose recommendations for follow-up and monitoring of metabolic and cardiovascular risk markers during GAHT. Available data show no increased risk for type 2 diabetes in transgender cohorts, but masculinising GAHT increases lean body mass and feminising GAHT is associated with higher fat mass and insulin resistance. The risk of CVD is increased in transgender cohorts, especially during feminising GAHT. Masculinising GAHT is associated with a more adverse lipid profile, higher haematocrit and increased BP, while feminising GAHT is associated with pro-coagulant changes and lower HDL-cholesterol. Assigned male sex at birth, higher age at initiation of GAHT and use of cyproterone acetate are separate risk factors for adverse CVD markers. Metabolic and CVD outcomes may improve during gender-affirming care due to a reduction in minority stress, improved lifestyle and closer surveillance leading to optimised preventive medication (e.g. statins). GAHT should be individualised according to individual risk factors (i.e. drug, dose and form of administration); furthermore, doctors need to discuss lifestyle and preventive medications in order to modify metabolic and CVD risk during GAHT. Follow-up programmes must address the usual cardiovascular risk markers but should consider that biological age and sex may influence individual risk profiling including mental health, lifestyle and novel cardiovascular risk markers during GAHT.
跨性别认同通常与性别焦虑和少数群体压力有关。性别肯定激素治疗（GAHT）包括男性化或女性化治疗，在大多数情况下预计是终身的。性和性激素对顺性别者的代谢和心血管疾病有不同的影响，在性腺功能减退症中使用性激素替代治疗与更高的血管风险相关，尤其是在老年个体中。我们使用叙述性综述方法，介绍了 GAHT 期间代谢和心血管结局的证据，并提出了 GAHT 期间代谢和心血管风险标志物随访和监测的建议。现有数据显示，跨性别队列中 2 型糖尿病的风险没有增加，但男性化 GAHT 会增加瘦体重，而女性化 GAHT 与更高的脂肪量和胰岛素抵抗有关。心血管疾病的风险在跨性别队列中增加，尤其是在女性化 GAHT 期间。男性化 GAHT 与更不利的血脂谱、更高的血细胞比容和血压升高有关，而女性化 GAHT 与促凝变化和 HDL-胆固醇降低有关。出生时被指定为男性、GAHT 开始年龄较高和使用醋酸环丙孕酮是不良 CVD 标志物的独立危险因素。由于少数民族压力的减轻、生活方式的改善和更密切的监测导致优化的预防性药物（如他汀类药物）的使用，性别肯定护理可能会改善代谢和心血管结局。GAHT 应根据个体危险因素（即药物、剂量和给药形式）进行个体化；此外，医生需要讨论生活方式和预防性药物，以便在 GAHT 期间改变代谢和心血管风险。随访计划必须解决常见的心血管风险标志物，但应考虑到生物年龄和性别可能会影响个体风险概况，包括 GAHT 期间的心理健康、生活方式和新的心血管风险标志物。
