全科诊所中性别肯定治疗所开具睾酮的不良反应监测与报告——来自“推动！”审计的数据
Monitoring and reporting of adverse effects of testosterone prescribing for gender affirmation at general practice clinics - Data from the PUSH! Audit.
作者信息
Eu Beng, Dawe Joshua, Dunn Matthew, Grace Julian, Lee Kevin, Griffiths Scott, Bloch Mark, Baker David, Soo Clara, Bisshop Fiona, Stoové Mark
机构信息
General Practice, Prahran Market Clinic, Melbourne, Australia.
Epidemiology, Burnet Institute, Melbourne, Australia.
出版信息
Int J Transgend Health. 2023 Oct 31;25(4):770-777. doi: 10.1080/26895269.2023.2271903. eCollection 2024.
INTRODUCTION
Prescribing testosterone for gender affirming hormone therapy (GAHT) has been increasing in Australia with much of this practice done by general practitioners (GPs) and there are current AusPATH guidelines on how this can be done appropriately. There has been limited data collected from GPs about how well these patients are monitored and the adverse effects (AEs) that are experienced by this population of patients.
OBJECTIVES
The primary objective of this study was to collect data about monitoring and adverse effects of GAHT provided in GP settings.
METHODS
The PUSH! Audit was a cross-sectional study that collected data from 9 GP Clinics across 5 Australian cities who provided GAHT with testosterone. Data was also collected about cisgender men who were prescribed testosterone for testosterone deficiency (TD) as a comparison group ( = 209).
RESULTS
The patients in the GAHT group ( = 277) tended to be younger (29.8 vs 54.9), with significant prevalence of smoking (21.8%) and anxiety/depression (37.2%) although this was not significantly higher that the comparison group. Most of the GAHT group had a testosterone level recorded in their file (90.6%) and the most common route of administration of testosterone was by intra-muscular injection (89.9%). The testosterone levels were mainly in the target range for males (75.7%) with only a small percentage registering levels above the target range (5.6%). Of the measured AEs, whilst there were significant prevalence of liver abnormalities and hypercholesterolemia, this was not significantly different to the TD group. The hypertension prevalence was lower in the GAHT group. Of the reported AEs, acne (10.1%) and balding (4.7%) were the only two AEs that were significantly reported.
CONCLUSION
This study shows that GAHT with testosterone can be provided effectively in general practice with high levels of success and very low levels of AEs.
引言
在澳大利亚，为性别确认激素疗法（GAHT）开具睾酮处方的情况日益增多，其中大部分由全科医生（GP）进行，并且目前有AusPATH指南指导如何恰当地进行此项操作。从全科医生处收集到的数据有限，内容涉及对这些患者的监测情况以及该患者群体所经历的不良反应（AE）。
目的
本研究的主要目的是收集关于全科医生诊所提供的GAHT的监测和不良反应的数据。
方法
“推动！审计”是一项横断面研究，从澳大利亚5个城市的9家提供含睾酮GAHT的全科医生诊所收集数据。还收集了因睾酮缺乏（TD）而开具睾酮处方的顺性别男性作为对照组的数据（n = 209）。
结果
GAHT组的患者（n = 277）往往更年轻（29.8岁对54.9岁），吸烟率（21.8%）和焦虑/抑郁发生率（37.2%）较高，尽管这并不显著高于对照组。GAHT组的大多数患者病历中有睾酮水平记录（90.6%），最常见的睾酮给药途径是肌肉注射（89.9%）。睾酮水平主要处于男性目标范围内（75.7%），只有一小部分高于目标范围（5.6%）。在所测量的不良反应中，虽然肝脏异常和高胆固醇血症的发生率较高，但与TD组没有显著差异。GAHT组的高血压患病率较低。在报告的不良反应中，痤疮（10.1%）和脱发（4.7%）是仅有的两项显著报告的不良反应。
结论
本研究表明，在全科医疗中，含睾酮的GAHT可以有效提供，成功率高且不良反应发生率极低。
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