transgender个体中的胆囊疾病：与性别肯定激素治疗的关联
Gallbladder disease in transgender individuals: associations with gender-affirming hormone therapy.
作者信息
Tabernacki Tomasz, Loria Matthew, Rhodes Stephen, Pope Rachel, Gupta Shubham, Banik Swagata, Mishra Kirtishri
机构信息
Case Western Reserve University School of Medicine, Cleveland, USA.
University Hospitals Urology Institute, Cleveland, USA.
出版信息
Int J Transgend Health. 2023 Nov 23;25(4):896-910. doi: 10.1080/26895269.2023.2283532. eCollection 2024.
BACKGROUND
Transgender individuals frequently undergo gender-affirming hormone therapy (GAHT) during their gender transition which plays a vital role in gender identity affirmation. Cholelithiasis, a common condition affecting 10-15% of the US population, has been linked to estrogen therapy in cisgender women. Despite the fact that hormonal profiles achieved after GAHT are not always identical to cisgender individuals, the effects of GAHT on gallbladder disease (GBD) risk have not been evaluated in transgender populations. This research aims to address this gap utilizing a large nationwide database.
METHODS
The study analyzed medical records data from the TrinetX database from 52,847 trans men and 38,114 trans women. Four cohorts were created: trans women and men either receiving either hormone therapy or no intervention. Descriptive statistics were calculated before matching to estimate disease burden. The groups were then propensity score matched on known risk factors (age, race, BMI, etc.) and rates of GBD were compared.
RESULTS
Before matching, trans women on hormone therapy (TWHT) had a significantly higher 10-year GBD probability than those naïve to therapy (TWNI) (4.69% vs 1.88%). For trans men, there was no significant difference in 10-year rates between those on therapy (TMHT) and those not (TMNI) (3.15% vs 3.87%). Cholecystectomy rates were significantly higher for TWHT than TWNI (1.10% vs. 0.57%), but similar between TMHT and TMNI (0.95% vs. 1.10%). After accounting for risk factors, TWHT had increased GBD risk (HR 1.832), while TMHT showed no significant change.
DISCUSSION
This study suggests a link between estrogen GAHT and increased GBD risk in transgender women. Notably, testosterone GAHT did not offer protection against GBD in transgender men, contrary to expectations. This study is, to our knowledge, the first to describe the burden of GBD in the transgender population and to investigate the effects of GAHT on GBD risk.
背景
跨性别者在性别转变过程中经常接受性别确认激素治疗（GAHT），这在性别认同确认中起着至关重要的作用。胆结石是一种常见疾病，影响着美国10%至15%的人口，已被证明与顺性别女性的雌激素治疗有关。尽管GAHT后达到的激素水平并不总是与顺性别者相同，但GAHT对跨性别者胆囊疾病（GBD）风险的影响尚未得到评估。本研究旨在利用一个大型全国性数据库填补这一空白。
方法
该研究分析了来自TrinetX数据库的52847名跨性别男性和38114名跨性别女性的医疗记录数据。创建了四个队列：接受激素治疗或未接受干预的跨性别女性和男性。在匹配之前计算描述性统计数据以估计疾病负担。然后根据已知风险因素（年龄、种族、BMI等）对各组进行倾向评分匹配，并比较GBD的发生率。
结果
在匹配之前，接受激素治疗的跨性别女性（TWHT）的10年GBD概率显著高于未接受治疗的跨性别女性（TWNI）（4.69%对1.88%）。对于跨性别男性，接受治疗者（TMHT）和未接受治疗者（TMNI）的10年利率没有显著差异（3.15%对3.87%）。TWHT的胆囊切除术发生率显著高于TWNI（1.10%对0.57%），但TMHT和TMNI之间相似（0.95%对1.10%）。在考虑风险因素后，TWHT的GBD风险增加（HR 1.832），而TMHT没有显著变化。
讨论
本研究表明雌激素GAHT与跨性别女性GBD风险增加之间存在联系。值得注意的是，与预期相反，睾酮GAHT并未为跨性别男性预防GBD提供保护。据我们所知，本研究是首次描述跨性别者中GBD的负担并调查GAHT对GBD风险影响的研究。
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