ESPE2023 Poster Category 1 Sex Differentiation, Gonads and Gynaecology, and Sex Endocrinology (56 abstracts)
Metabolic health status and cortisol metabolism of adolescents with gender incongruence / gender dysphoria during process of diagnosis
Aneta Gawlik 1 , Aleksandra Antosz 1 , Iga Chmiel-Aleksandrowicz 1 , Aleksandra Januszek-Trzciąkowska 1 , Dorota Karbowska 1 , Jakub Gawlik 2 , Zuzanna Nowak 2 & Tomasz Jakubowski 1,3
1Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland. 2Student Scientific Society at the Department of Pathophysiology, Jagiellonian University Medical College, Kraków, Poland. 3Institute of Psychology, Faculty of Social Sciences, University of Silesia in Katowice, Katowice, Poland
Introduction: Gender incongruence (GI) is a condition where a person's gender identity does not match their assigned sex at birth, and can lead to significant distress and gender dysphoria (GD). In various studies it has been associated with a predisposition to developing pathological eating behaviours, which in turn negatively influence the individual’s metabolic health. In our study we examine selected markers of metabolic condition and assess surrogates of cortisol metabolism reflecting stress in a population of adolescents with GI/GD during their diagnosis process.
Methods: This prospective study has examined 181 adolescents admitted due to GI/GD to one clinical center between 2017 and 2022. History of gender identity incongruence and gender dysphoria has been analysed alongside hormonal, metabolic and anthropometric parameters. The population has been divided into assigned female at birth (AFAB) and assigned male at birth (AMAB) groups.
Results: The population consists of 181 participants (153 AFAB, 28 AMAB), with the mean age of 15.8 ± 1.7 years and the mean age of gender identity mismatch onset of 11.4 ± 2.8 years. BMI distribution, components of the metabolic syndrome, midnight serum cortisol and glucocorticoids metabolites in the 24hr-urine collection are presented in table (** - AFAB vs. AMAB P<0.05)
| Variables | All (n=181) | AFAB (n=153) | AMAB (n=28) | |
| BMI (centiles) | ||||
| >97 | 22% | 25% | 7% | |
| 90-97 | 15% | 16% | 14% | |
| 10-90 | 51% | 50% | 60% | |
| 3-10 | 7% | 7% | 7% | |
| <3 | 3% | 2% | 10% | |
| Fasting blood | glucose >100 mg/dl | 7% | 7% | 4% |
| triglycerides >150 mg/dl | 8% | 10% | 0% | |
| HOMA-IR >2.5 | 36% | 36% | 36% | |
| HDL-cholesterol <40 mg/dl | 10% | 8% | 18% | |
| midnight cortisol >5.7 mg/dl | 8% | 8% | 7% | |
| 24-hr urinary collection (steroid metabolom) | THE/tetrahydrocortisone ** | 11% | 7% | 35% |
| THF/tetrahydrocortisol** | 7% | 5% | 21% | |
| α THF/ α tetrahydrocortisol | 1% | 1% | 0% | |
| α-Cl / α-cortolone ** | 8% | 5% | 21% | |
| β-Cl / β-cortolone ** | 9% | 5% | 29% | |
| β-C / β-cortol | 3% | 4% | 0% | |
| α-C / α-cortol ** | 10% | 5% | 39% | |
| E/cortison** | 5% | 3% | 18% | |
| F/cortisol** | 5% | 3% | 18% | |
Conclusion: The increased risk of abnormal BMI, mostly increased in AFAB and decreased in AMAB, and higher risk of metabolic syndrome/complications are valuable insights when dealing with patients during the preparation for medical transition. Increased concentrations of glucocorticoids metabolites may reflect excessive stress, especially in the AMAB patients.
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