ESPE Abstracts

Background: Transgender adolescents may be treated with gender affirming hormone therapy (GAHT) consisting of gonadotropin-releasing hormone agonists (GnRHa) and cross-sex hormones. Limited data are available regarding the metabolic effects of GAHT in adolescence.

Objective: To evaluate the lipid profiles and HbA1c in transgender adolescents after one year of cross-hormone treatment.

Patients and Methods: 117 adolescents assigned female and 38 assigned male at birth who started GAHT between May 2016 and September 2020 were retrospectively identified in a national cohort treated in a single-center setting. Non-fasting lipid profiles and HbA1c were collected from patient records. Seventy-six trans males and 22 trans females who had lipid profiles controlled 1 year ± 4 months after starting cross-sex hormones, were included in the study. In 33 trans males and 9 trans females HbA1c was also obtained. Age when starting GAHT, lipid profiles and HbA1c were compared between trans males and trans females using the student`s t-test. Lipid profiles and HbA1c were compared with normal reference intervals.

Results: The mean (SD) age in trans males and trans females when starting GnRHa was 16.6 (1.2) versus 16.3 (1.5), P=0.38, and when starting cross-hormones 17.0 (0.9) versus 17.0 (1.1), P=0.19. After one year of receiving cross-sex hormones, there were no significant differences between trans males and trans females in mean (SD) cholesterol (mmol/L) (4.1 (0.8) versus 4.1 (0.8), P=0.62), low-density lipoprotein (LDL) (mmol/L) (2.6 (0.8) versus 2.4 (0.6), P=0.82), high-density lipoprotein (HDL) (mmol/L) (1.29 (0.26) versus 1.57 (0.33), P=0.13), or HbA1c (mmol/mol) (33 (4) versus 31 (2), P=0.13). Twelve% of trans males and 14% of trans females had cholesterol above the normal reference intervals (<5 mmol/L), 23% of trans males and 24% of trans females had LDL (mmol/L) above the normal reference intervals (<3.0 mmol/L). Twelve% of trans males and 9% of trans females had HDL (mmol/L) below the normal reference intervals (>1.0 mmol/L). HbA1c was within the normal reference intervals (<48 mmol/mol) in all cases.

Conclusion: In this national cohort there were no significant differences in lipid profiles or HbA1c between trans males and trans females one year after starting cross-sex hormones. HbA1c was normal in all cases but a significant number of both trans males and females showed deviating lipid profiles compared with normal reference intervals. Whether cross-sex hormone treatment interferes with lipid metabolism needs to be further explored.