Purpose: Transgender adolescents are treated with gonadotropin-releasing hormone analogues (GnRHa), followed by the addition of gender-affirming hormones. Since during puberty the body reaches maturation, concerns have been risen that the treatment may have negative outcome later in life. The aim of this study is to determine whether treatment with GnRHa and subsequent addition of hormones results in a more atherogenic profile than peers at the age of 22.
Methods: This retrospective study included 71 young adult transwomen (birth-assigned boys) and 121 young adult transmen (birth-assigned girls) diagnosed with gender dysphoria (DSM-IV TR) in their teens. Treatment included solely GnRHa from the age of 12, the addition of hormones from the age of 16, and gonadectomy from the age of 18 with cessation of GnRHa. At the start of GnRHa treatment, at the start adding hormones, and at the age of 22 body mass index (BMI) was measured and a fasting state blood sample was taken to examine insulin sensitivity (HOMA-IR) and lipids. Standard deviation scores (SDS) were calculated to compare values with reference data from male peers (cismen) and female peers (ciswomen) which were retrieved from literature. Informed consent was signed.
Results: Duration of GnRHa monotherapy was 2.1 years (median, inter quartile range (IQR) 1.02.8) in transwomen and 1.0 years (median, IQR 0.52.9) in transmen. Combination of GnRHa and hormones lasted 3.1 years (median, IQR 2.53.6) in transwomen and 2.4 years (median, IQR 2.03.1) in transmen. Transwomen at 22 had, in comparison with ciswomen, SDS of +0.2 (95% confidence interval (CI) −0.1;+0.5) for BMI, −0.4 (95% CI −1.9;+1.1) for HOMA-IR, −0.4 (95% CI -−.7;−0.1) for total cholesterol, +0.8 (95% CI +0.5;+1.2) for HDL-C, −1.0 (95% CI −1.3;−0.6) for LDL-C, and +0.2 (95% CI −0.3;+0.7) for triglycerides. In comparison with cismen, SDS in transmen were +0.3 (95% CI +0.2;+0.5) for BMI, −0.6 (95% CI −1.0;−0.2) for HOMA-IR, +0.1 (95% CI −0.2;+0.4) for total cholesterol, +0.3 (95% CI +0.1;+0.4) for HDL-C, −0.1 (95% CI −0.4;+0.2) for LDL-C, and +0.1 (95% CI −0.2;+0.4) for triglycerides.
Conclusion: At the age of 22, the metabolic profile of transwomen is even or less atherogenic than in female peers. Transmen had a higher BMI, and a lower insulin resistence than cismen with a comparable lipid profile.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology