madman
Super Moderator
Abstract
Background Reassignment of a female-to-male (FtM) person requires gender-affirming, the androgenic hormonal treatment that is planned to induce appropriate structural changes. This therapy must be prolonged long term, even after the sex reassignment surgery (SRS). The purpose of this study is to evaluate the effects of hormone therapy with testosterone in FtM subjects during a 24-month follow-up in order to highlight the occasional need for early decompensation and to make adequate hormone therapy modulations.
Methods Fifteen out of 23 FtM persons had been previously treated with SRS, while eight were still awaiting surgery. During hormone therapy, both groups were followed for 24 months, with an evaluation of desired changes, adverse effects, and functional or metabolic indicators.
Results In the group of operated FtM subjects (15/23), a significant increase of total testosterone (total T) and free testosterone (free T) was found after 24 months. Luteinizing hormone (LH) maintained a low level, decreasing after ovariectomy, while FSH increased. Voice deepening, facial and body hair variation, male-pattern balding, and body mass index (BMI) increase are all physical changes due to androgenization. In both groups of patients who have been closely monitored, the side effects and thromboembolic, metabolic, and cardiovascular risks of androgen therapy, even in the long term, appear to be irrelevant.
Conclusion Total T, free T, and LH dosages are shown to be reliable markers of correct androgenization. Strict monitoring of lipid profile, evaluation of BMI and hematocrit, avoidance of self-initiated therapeutic modifications, adherence to a healthy lifestyle, and avoidance of excessive daily calorie intake can limit risks linked to long-term testosterone administration.
Background
Gender reassignment for the female patient affected by “gender dysphoria” (FtM—female-to-male transgender patient) is preceded by and associated with androgenic hormonal treatment in order to induce appropriate structural changes and to obtain a male phenotype [1]. To correctly manage the gender dysphoria, it is essential to verify that the criteria put forth in the DSM 5 [2] are completely fulfilled. At the same time, a period of up to 12 months (reversible gender reassignment) is sometimes necessary to assess the severity of the gender dysphoria and to determine if the patient will benefit from a definitive transition process, including sex reassignment surgery (SRS), which is an irreversible gender change [3]. Therefore, hormonal therapy is an essential step during the reversible phase of the sexual transition process and must be prolonged for many years even after the SRS [4]. Periodic monitoring of metabolic and hormonal changes during the hormonal treatment allows a determination of the correlation between type and dose of testosterone administered, serum hormonal levels, and the clinical phenotypic changes so as to achieve a personalized adjustment of testosterone dosage [5]. The purpose of this study is to describe how hormone treatment can change metabolic and hematological indices so that periodic clinical monitoring may ensure the safety and efficacy of long-term hormone therapy.
Conclusions
In this study, we obtained statistically significant data on hormonal and metabolic indicators in FtM transgender subjects who underwent SRS. We are able to confirm that LH proved to be a valid marker of cross-sex hormonal therapy since its reduction under the value of 10 mi/ml corresponded to an optimal endocrine, metabolic, and hemato-chemical degree of androgenization. Moreover, during personalized followup, we analyzed lipid profile [23] as an indicator of correct hormonal dosage, and this was shown to be useful in preventing thromboembolic events and endocrinological and metabolic imbalance [24, 25]. We believe that the lipid profiles should be examined before the initiation of androgen treatment. However, close attention should be paid to early detection of subjects who have a constitutional predisposition to hypercholesterolemia. Moreover, great care must also be taken as to recommendations concerning lifestyle and proper nutrition, although this is more difficult to achieve among young people [26]. In addition, in operated FtM subjects, androgens used as a long-term treatment, in particular when associated with estrogen deficiency due to ovariectomy, may induce metabolic changes related to long-term atherosclerotic risk [27, 28]. These risks can be limited by strict monitoring of lipid profile [29], regular BMI and HCT evaluation, avoidance of self-management of therapy, and adherence to a healthy lifestyle, without alcohol, smoking, or excessive daily calorie intake [30]. Institutions should be encouraged to set up more specialized centers and to enable minor regional hospital wards with specialists dedicated to the care of transgender people undergoing long-term hormone treatment.
Background Reassignment of a female-to-male (FtM) person requires gender-affirming, the androgenic hormonal treatment that is planned to induce appropriate structural changes. This therapy must be prolonged long term, even after the sex reassignment surgery (SRS). The purpose of this study is to evaluate the effects of hormone therapy with testosterone in FtM subjects during a 24-month follow-up in order to highlight the occasional need for early decompensation and to make adequate hormone therapy modulations.
Methods Fifteen out of 23 FtM persons had been previously treated with SRS, while eight were still awaiting surgery. During hormone therapy, both groups were followed for 24 months, with an evaluation of desired changes, adverse effects, and functional or metabolic indicators.
Results In the group of operated FtM subjects (15/23), a significant increase of total testosterone (total T) and free testosterone (free T) was found after 24 months. Luteinizing hormone (LH) maintained a low level, decreasing after ovariectomy, while FSH increased. Voice deepening, facial and body hair variation, male-pattern balding, and body mass index (BMI) increase are all physical changes due to androgenization. In both groups of patients who have been closely monitored, the side effects and thromboembolic, metabolic, and cardiovascular risks of androgen therapy, even in the long term, appear to be irrelevant.
Conclusion Total T, free T, and LH dosages are shown to be reliable markers of correct androgenization. Strict monitoring of lipid profile, evaluation of BMI and hematocrit, avoidance of self-initiated therapeutic modifications, adherence to a healthy lifestyle, and avoidance of excessive daily calorie intake can limit risks linked to long-term testosterone administration.
Background
Gender reassignment for the female patient affected by “gender dysphoria” (FtM—female-to-male transgender patient) is preceded by and associated with androgenic hormonal treatment in order to induce appropriate structural changes and to obtain a male phenotype [1]. To correctly manage the gender dysphoria, it is essential to verify that the criteria put forth in the DSM 5 [2] are completely fulfilled. At the same time, a period of up to 12 months (reversible gender reassignment) is sometimes necessary to assess the severity of the gender dysphoria and to determine if the patient will benefit from a definitive transition process, including sex reassignment surgery (SRS), which is an irreversible gender change [3]. Therefore, hormonal therapy is an essential step during the reversible phase of the sexual transition process and must be prolonged for many years even after the SRS [4]. Periodic monitoring of metabolic and hormonal changes during the hormonal treatment allows a determination of the correlation between type and dose of testosterone administered, serum hormonal levels, and the clinical phenotypic changes so as to achieve a personalized adjustment of testosterone dosage [5]. The purpose of this study is to describe how hormone treatment can change metabolic and hematological indices so that periodic clinical monitoring may ensure the safety and efficacy of long-term hormone therapy.
Conclusions
In this study, we obtained statistically significant data on hormonal and metabolic indicators in FtM transgender subjects who underwent SRS. We are able to confirm that LH proved to be a valid marker of cross-sex hormonal therapy since its reduction under the value of 10 mi/ml corresponded to an optimal endocrine, metabolic, and hemato-chemical degree of androgenization. Moreover, during personalized followup, we analyzed lipid profile [23] as an indicator of correct hormonal dosage, and this was shown to be useful in preventing thromboembolic events and endocrinological and metabolic imbalance [24, 25]. We believe that the lipid profiles should be examined before the initiation of androgen treatment. However, close attention should be paid to early detection of subjects who have a constitutional predisposition to hypercholesterolemia. Moreover, great care must also be taken as to recommendations concerning lifestyle and proper nutrition, although this is more difficult to achieve among young people [26]. In addition, in operated FtM subjects, androgens used as a long-term treatment, in particular when associated with estrogen deficiency due to ovariectomy, may induce metabolic changes related to long-term atherosclerotic risk [27, 28]. These risks can be limited by strict monitoring of lipid profile [29], regular BMI and HCT evaluation, avoidance of self-management of therapy, and adherence to a healthy lifestyle, without alcohol, smoking, or excessive daily calorie intake [30]. Institutions should be encouraged to set up more specialized centers and to enable minor regional hospital wards with specialists dedicated to the care of transgender people undergoing long-term hormone treatment.
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