Gender-affirming Hormonal Therapy Research Articles

Early changes in muscle strength and body composition under gender-affirming hormonal therapy in transgender people assigned female at birth

Early changes in muscle strength and body composition under gender-affirming hormonal therapy in transgender people assigned female at birth

Incidence of Type 2 Diabetes Mellitus in Transgender Individuals Undergoing Gender Affirming Hormonal Therapy: A Systematic Review.

Gender-affirming hormonal therapy (GAHT), which includes estrogen, testosterone, androgen agonists, is commonly used in transgender individuals to change their secondary sexual characteristics to align with their gender identity. However, this treatment could result in metabolic side effects that could increase the chances of acquiring type 2 diabetes mellitus. Thus, this study aims to compare differences in body mass index (BMI), insulin resistance, and the incidence of type 2 diabetes mellitus between cisgender and transgender individuals undergoing GAHT. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, we conducted a systematic review searching through PubMed, Google Scholar, Medline (Medical Literature Analysis and Retrieval System Online), and ResearchGate for articles published between 2014 and 2024. The final search was conducted in February 2024. Out of the 3,934 articles reviewed, 11 were selected, focusing on insulin sensitivity/resistance, diabetes incidence, and BMI changes with GAHT. Although our result findings did not show clear evidence of increased diabetes incidence among GAHT patients, it was observed that GAHT does increase BMI and insulin resistance in transgender individuals. Notably, compared to transgender men, transgender women on GAHT were found to be more prone to insulin resistance. We recommend regularly monitoring insulin sensitivity parameters and HbA1c during GAHT to monitor metabolic side effects. Further research and more clinical trials are needed to confirm the GAHT's impact on insulin resistance and to evaluate its role in the onset of type 2 diabetes mellitus.

Cardiopulmonary Exercise Testing in Transgender and Gender-Diverse Patients: The Influence of Sex and Gender on Predicted Aerobic Capacity

BackgroundSex assigned at birth (SAB) is currently used to calculate predicted normative values for oxygen consumption (VO2) during cardiopulmonary exercise testing (CPET) in transgender and gender diverse (TGD) patients. It is unclear if this is physiologically valid once gender-affirming hormonal therapy (GAHT) has been instituted. Research QuestionWhat are the changes in functional aerobic capacity (FAC) and in percentage of predicted (%pred) peak VO2 when gender is used, instead of SAB, to estimated normative predicted values among TGD patients >14 years of age who are receiving GAHT? Study Design and MethodsWe retrospectively analyzed 16 referred TGD patients (8 transgender men, 8 transgender women) receiving GAHT therapy at the time of the test. Data collected and analyzed included: clinical indication for CPET, biometrics (age, height, and weight), CPET parameters (treadmill, Mayo Clinic protocol, without chest binder), chest imaging, echocardiographic results, and hemoglobin levels. ResultsIn transgender women, the use of gender congruent normative predictive values, instead of SAB, significantly increased FAC (69.70 ± 4.35 vs. 87.82 ± 5.15 [%]; mean ± SE; for SAB and gender, respectively; p= <0.0001) and %pred peak VO2 (66.53 ± 4.17 vs. 89.69 ± 5.60 [%]; mean ± SE; for SAB and gender, respectively; p= <0.0001). In transgender men, the use of gender congruent normative predictive values showed that both FAC and %pred peak VO2 significantly decreased (approximately 20% and 25%, respectively). Deconditioning was the most frequent CPET finding among transgender men. InterpretationAmong TGD individuals receiving GAHT, the use of gender to calculate normative values affects %pred peak exercise VO2 and FAC significantly. Body composition changes after GAHT require regular monitoring of muscle strength, lean body mass, and aerobic capacity. Cardiopulmonary symptoms among TGD patients should be assessed with these variables in mind –especially in the presence of chronic cardiac and pulmonary diseases.

Exploring Hormone Therapy Effects on Reproduction and Health in Transgender Individuals.

Transgender individuals often face elevated mental health challenges due to gender dysphoria, but gender-affirming treatments such as surgery and hormone therapy have been linked to significant improvements in mental well-being. The potential influence of time and circadian rhythms on these treatments is prevalent. The intricate interplay between hormones, clock genes, and fertility is profound, acknowledging the complexity of reproductive health in transgender individuals. Furthermore, risks associated with gender-affirming hormonal therapy and potential complications of puberty suppression emphasize the importance of ongoing surveillance for these patients and the need of fertility preservation and family-building options for transgender individuals. This narrative review delves into the intricate landscape of hormone therapy for transgender individuals, shedding light on its impact on bone, cardiovascular, and overall health. It explores how hormone therapy affects bone maintenance and cardiovascular risk factors, outlining the complex interplay of testosterone and estrogen. It also underscores the necessity for further research, especially regarding the long-term effects of transgender hormones. This project emphasizes the critical role of healthcare providers, particularly obstetricians and gynecologists, in providing affirming care, calling for comprehensive understanding and integration of transgender treatments. This review will contribute to a better understanding of the impact of hormone therapy on reproductive health and overall well-being in transgender individuals. It will provide valuable insights for healthcare providers, policymakers, and transgender individuals themselves, informing decision-making regarding hormone therapy and fertility preservation options. Additionally, by identifying research gaps, this review will guide future studies to address the evolving healthcare needs of transgender individuals. This project represents a critical step toward addressing the complex healthcare needs of this population. By synthesizing existing knowledge and highlighting areas for further investigation, this review aims to improve the quality of care and support provided to transgender individuals, ultimately enhancing their reproductive health and overall well-being.

Access to gender-affirming hormonal therapy in Russia: perspectives of trans people and endocrinologists

Purpose Worldwide, trans people are known to take hormones without prescription or take higher or lower doses than prescribed. The study’s goal was examination of the social context behind provision and receiving of gender-affirming hormonal therapy (GAHT) in Russia, as well as collection of opinions on the organization of healthcare. Methods Semi-structured interviews with 20 trans individuals and 6 endocrinologists. Results Trans respondents started GAHT between 2004 and 2022. Over that period, the number of trans-competent endocrinologists increased and it became easier to receive the diagnosis F64.0 “transsexualism” (ICD-10), which qualifies one to obtain GAHT. However, the majority still took hormones without supervision. The reasons for self-medication included: the lack of the diagnosis, high cost of appointments and tests, age under 18, and self-perceived understanding of principles of GAHT. Most endocrinologists learnt about GAHT after being approached by a trans patient. They received information from advanced training courses and academic literature. The specialists had diverse opinions on the ideal policy of providing GAHT to trans people, but all claimed that in Russian political realities they found the diagnosis “transsexualism” a necessary prerequisite for initiating GAHT to safeguard both doctors and patients. Conclusions The lack of strict law enforcement in the pharmacological sphere in Russia enabled many trans people to initiate GAHT without supervision. Trans-competent endocrinologists were available for those who needed them. Under current political circumstances it is unlikely that the informed consent model (prescription without a psychiatric diagnosis) can be implemented in Russia.

OR31-03 Testosterone Gender-affirming Hormonal Therapy Is Associated With Decreased Cerebral Blood Flow In Transgender Teens

Abstract Disclosure: S. Cote: None. K. Fathy: None. S. Lenet: None. O. Espinosa-Bentancourt: None. E. Lavallee: None. E. Croteau: None. D. Rottembourg: None. J. Lepage: None. K. Whittingstall: None. There is increasing demand for gender-affirming hormonal therapy (GAHT) in recent years, with increased access to GAHT for transgender teenagers. While it is well documented that psychological outcomes and quality of life improve after GAHT, it remains unclear how cerebrovascular physiology changes with GAHT. Therefore, this study aimed to investigate the effects of testosterone GAHT on cerebral microvascular and macrovascular physiology in teenage transgender men receiving GAHT. Six teenage transgender men were referred by their endocrinologist prior to the start of GAHT. Participants visited the research center before GAHT (session 1) and between 3 to 9 months into their GHAT (session 2). At each visit, participants completed a non-contrast-enhanced magnetic resonance imaging (MRI) protocol. This protocol assessed the macrovasculature using time-of-flight magnetic resonance angiography to visualize cerebral arteries and estimate diameters of the Circle of Willis and 2D-Phase Contrast to estimate large artery blood velocity. The microvasculature was assessed using pseudo-Continuous Arterial Spin Labelling, which estimates cerebral blood flow (CBF). Paired-sample t-tests were performed between sessions to determine if arterial diameters, CBF and blood velocity change with GAHT. Whole-brain CBF significantly decreased with GAHT between session 1 and session 2 (CBFS1=69.15 +/- 5.85 ml/100g/min; CBFS2=59.30 +/- 8.11 ml/100g/min; t=3.19, p=0.02, df=5). The average percent change in CBF was -9.85%, and the largest decrease experienced by a participant was -20.44%. Note that even though CBF decreased, average whole-brain CBF for all participants remained in a healthy range. We observed no significant change in large artery blood velocity or arterial lumen diameters of the Circle of Willis after starting GAHT. Our results suggest that GAHT influences the brain’s microvasculature. As women tend to have higher CBF than men, the reduction in CBF likely reflects a masculinization of the brain with GAHT. Without EEG to probe neuronal activity, it is difficult to determine if the change is due to decreased neuronal activity or a structural and/or functional change in the microvasculature. Considering that little is known about the long-term effects of GAHT on the brain, these results highlight the need to better understand how hormonal states impact human cerebrovascular physiology and how it may relate to risk for cerebrovascular disease and neurological disorders. Presentation: Sunday, June 18, 2023

SAT420 Bone Health In Transgender People

Abstract Disclosure: G. Grande: None. C. Ceolin: None. B. Vescovi: None. M. Dall’Agnol: None. C. Ziliotto: None. S. Pasqualini: None. G. Petre: None. A. Scala: None. S. Giannini: None. V. Camozzi: None. A. Bertocco: None. G. Sergi: None. A. Ferlin: None. A. Garolla: None. In transgender subjects, worse Bone Mineral Density (BMD) values were observed when compared to cisgender controls before initiating Gender-Affirming Hormonal Therapy (GAHT). The reasons have not yet been fully clarified. In this study we analyzed bone metabolism and body composition in a population of transgender people before initiating GAHT, and their possible correlation with endocrine profile, mental health, and lifestyle habits. Medical data, phosphocalcic metabolism and hormonal parameters, lumbar and femoral bone mineral density, body composition, strength and psychological well-being (by Patient Health Questionnaire-9-PHQ-9 and Perceived Stress Scale-PSS questionnaires), were collected in a sample of 32 transgender people before GAHT initiation and 32 cisgender controls. Assigned Female At Birth (AFAB) transgender people presented worse Z-score values at total hip and neck femoral sites (-0.52±0.94 vs 0.15±0.82, and -0.37±0.79 vs 0.19±0.66, p=0.04 respectively), while in Assigned Male At Birth (AMAB) transgender people also lumbar sites were compromised in comparison to cisgender controls. No significant difference in phospho-calcium metabolism (calcium, phosphate, PTH and vitamin D) or hormonal profile (Testosterone, estradiol, LH, FSH) was found between the transgender and the cisgender group. PHQ-9 (a questionnaire to screen for depression) scores were higher in the transgender population than cisgender controls (9.35±7.41 vs 4.08±3.14, p=0.03 in AFAB and 9.54±5.45 vs 4.46±3.59, p=0.02 in AMAB transgender people). Multiple regression analysis identified PSS (a tool to assess stress levels and identify which situations are perceived as stressful) score as an independent predictor of total femur BMD, explaining about 54% of the variance. Transgender people before GAHT have worse bone health than cisgender subjects. In particular, BMD was reduced at the hip and in AMAB even at lumbar site. The reduction in bone mass before GAHT seems independent by hormonal and phospho-calcic profile and associated mostly with psychological status. Further study will clarify the specific pathogenetic mechanisms involved in bone growth in transgender people. However, according to our evidences, the psychological stress might influence negatively lifestyle habits therefore being involved in reduced bone health. Early lifestyle and psychological interventions might so be beneficial also for bone health in the transgender population. Presentation: Saturday, June 17, 2023

SAT406 Evaluation Of The Emotional And Cognitive Effects Of Hormone Therapy In Transgender Men And Women

Abstract Disclosure: I. Yaish: None. G. Keltch: None. Y. Greenman: None. K.M. Tordjman: None. Background:- Sex hormones have far-reaching effects on the brain, both emotionally and cognitively. - Varying levels of sex hormones are associated with altered emotional states and cognitive abilities. -No longitudinal study has assessed the impact of cross-sex hormone on these issues in young transgender people. Aim:•To prospectively evaluate the effect of gender-affirming hormonal therapy (GAHT) on cognition and emotional state in transgender men and women initiating therapy Subjects and Methods:- Transgender men (TM) aged 24.6±7.8 y (18-37), and 11 transgender women (TW) 27.3±9.4 (19-46).- Mood questionnaires (PHQ9 and GAD-7), and cognitive tests (short-term logical memory test, sub-tests of knowledge, forward and backward digit recall, number-coding and random learning from WAIS-III, a verbal fluency test and CTMT test) were administered prior to GAHT, and 3-6 months into treatment. - Scores were calculated for emotional stress, memory, attention, and executive functions. - Wilcoxon tests for paired samples assessed the impact of GAHT on these variables. Results - In TM, GAHT significantly improved executive functions but had no effect on memory, attention, and emotional stress. - In TW, GAHT significantly improved memory but had no effect on attention, executive functions, and emotional stress. - Despite a trend for improved emotional stress with GAHT in both groups, over this short study period, this was not significant. Conclusions:- - In keeping with the literature, this short preliminary study showed that estrogen contributes to memory, and testosterone to executive functions.-- This is the first time this has been shown in transgender individuals. -The lack of effect on emotional stress is probably due to the small sample size and short duration, larger studies should elucidate this point. Presentation: Saturday, June 17, 2023

FRI323 Prolactinoma Recurrence With Testosterone Treatment In Transgender Male

Abstract Disclosure: N. Arnouk: None. P.R. Schroeder: None. Introduction: We present a case of recurrent hyperprolactinemia due to testosterone treatment for gender-affirming hormonal therapy in a transgender male after being controlled on cabergoline for more than a year. Case: A 27-year-old female with history of HTN and polycystic ovary syndrome was diagnosed with pituitary microadenoma after hospital admission for headache and blurry vision. MRI brain showed a mass in the sella and right parasella measuring 36 mm W x 36 mm D x 44 mm H. Hormonal workup showed prolactin (PRL) &amp;gt;999 ng/mL in the diluted assay. The patient was treated medically with cabergoline and discharged home. PRL level improved to 22 ng/mL on treatment. Cabergoline was continued at 0.5 mg twice weekly. The patient was lost to follow-up but returned to clinic after 8 months with PRL level of 58 ng/mL. Cabergoline 0.5 mg twice weekly was continued. PRL level monitoring every ∼6 weeks showed an increase to 184 ng/mL and then 199 ng/mL. Cabergoline was increased to 1 mg twice weekly. PRL level 1 month later was 222 ng/mL. Repeat brain MRI showed markedly decreased microadenoma 4.8 X 2.6 mm. The patient was asymptomatic with no headache, blurry vision, or galactorrhea. On further questioning, the patient reported starting transgender female to male testosterone cypionate 200 mg/mL once weekly for the past 6 months. After discussion with the primary care provider who was managing testosterone treatment, he was started on 60 mg weekly, and the dose was gradually increased to 80 mg weekly to stop the menstrual period. With the 60-mg weekly cypionate dose, the testosterone level was 346 pg/mL, and PRL level was 184 ng/mL. With the cypionate dose of 80 mg weekly, PRL increased to 194 ng/mL and 222 ng/mL. The cypionate dose was decreased to 60 mg weekly, based on literature noting elevated PRL level with testosterone replacement in patients with prolactinoma and hypogonadism. Based on repeat blood work showing elevated testosterone 366 pg/mL with PRL 318 ng/mL, the plan is to start an aromatase inhibitor. Discussion: Testosterone treatment as hormonal affirming therapy in some transgender female to male patients may exacerbate pre-existing hyperprolactinemia or induce PRL secretion, thus close monitoring is required. Testosterone is aromatized to estradiol, which then stimulates the release of PRL from the pituitary gland. The serial measurement of estradiol may serve as an index of aromatization. Hyperprolactinemia in this setting is resistant to dopamine agonist therapy, as noted in multiple case reports. There are no established reference ranges for PRL levels for transgender patients on gender-affirming hormone therapy and no current guidelines regarding routine imaging or biochemical assessment during follow-up. Transgender patients with prolactinoma may require additional treatment with non-aromatizable androgens or the concomitant administration of aromatase inhibitors. Presentation: Friday, June 16, 2023

Prevalence of and factors associated with the use of gender-affirming hormonal therapy outside the reference regimen among transgender people in a community-led clinic in Metro Manila, Philippines: a retrospective cross-sectional study

ObjectivesWe aimed to describe the gender-affirming hormonal therapy (GAHT) intake behaviour and regimen and the factors associated with the use of hormones inconsistent with reference GAHT regimen among transgender people...

Bone health and body composition in transgender adults before gender-affirming hormonal therapy: data from the COMET study

PurposePreliminary data suggested that bone mineral density (BMD) in transgender adults before initiating gender-affirming hormone therapy (GAHT) is lower when compared to cisgender controls. In this study, we analyzed bone metabolism in a sample of transgender adults before GAHT, and its possible correlation with biochemical profile, body composition and lifestyle habits (i.e., tobacco smoke and physical activity).MethodsMedical data, smoking habits, phospho-calcic and hormonal blood tests and densitometric parameters were collected in a sample of 125 transgender adults, 78 Assigned Females At Birth (AFAB) and 47 Assigned Males At Birth (AMAB) before GAHT initiation and 146 cisgender controls (57 females and 89 males) matched by sex assigned at birth and age. 55 transgender and 46 cisgender controls also underwent a complete body composition evaluation and assessment of physical activity using the International Physical Activity Questionnaire (IPAQ).Results14.3% of transgender and 6.2% of cisgender sample, respectively, had z-score values < -2 (p = 0.04). We observed only lower vitamin D values in transgender sample regarding biochemical/hormonal profile. AFAB transgender people had more total fat mass, while AMAB transgender individuals had reduced total lean mass as compared to cisgender people (53.94 ± 7.74 vs 58.38 ± 6.91, p < 0.05). AFAB transgender adults were more likely to be active smokers and tend to spend more time indoor. Fat Mass Index (FMI) was correlated with lumbar and femur BMD both in transgender individuals, while no correlations were found between lean mass parameters and BMD in AMAB transgender people.ConclusionsBody composition and lifestyle factors could contribute to low BMD in transgender adults before GAHT.

IS THERE A DOSE OF CYPROTERONE ACETATE LOW ENOUGH TO AVOID HYPERTENSION DEVELOPMENT IN YOUNG TRANSGENDER WOMEN?

Objective: Cyproterone acetate (CPA) is a progestagen receptor agonist and androgen receptor antagonist widely used in gender-affirming hormonal therapy (GAHT) for transgender women. It is devoid of the mineralocorticoid blocking effect of native progesterone, thus its combination with oestradiol may elicit hydrosaline retention and hypertension. In a retrospective analysis we have found that using CPA for 5 years in young transgender women increases very significantly their SBP and their incidence of hypertension. Due to risks such as meningioma and liver toxicity, the European Medicines Agency (EMA) recommends avoiding doses &gt;10 mg/day if possible; however, present guidelines for GAHT recommend doses up to 100 mg/day. While lower doses may be effective and safer, the dose-dependence for hypertension development with CPA has not been studied. We undertook to study the association between the cumulative dose of CPA in young transgender women and their incidence of hypertension. Design and method: Retrospective review of the clinical records of female transgender people &lt;30-years-old treated with oestradiol + CPA for 5 years. All subjects gave informed consent. They were stratified by quartiles of cumulative CPA intake. We were unable to use doses &lt; 25 mg/day, as only 50 mg pills are available. Results: Data were obtained from 56 subjects. The global adjusted annualized incidence of hypertension 4.96% vs. 0.98% in the reference population (transgender women treated with oestradiol without antiandrogen). By quartiles the incidences were 2.52%/4.13%/5.76%/7.31%, p &lt;0.001 (Figure 1A). Their global adjusted SBP increase was 14 vs. 3 mmHg; by quartiles 7/11/16/22 mmHg, p &lt;0.001 (Figure 1B). Conclusions: We found a clear dose-dependence for the incidence of hypertension associated with CPA in young transgender women, but even the lowest doses we were able to manage did significantly increase the risk. We cannot however rule out that doses as low as 10 mg/day may be effective and safer. We believe that the present recommendations of high CPA doses for GAHT should be reconsidered.

Post-pubertal testosterone implants in female rats, a model of gender-affirming hormonal therapy, induce hypertension that is exaggerated with aging

Introduction: Early pre-pubertal exposure to androgens induces an increase in blood pressure (BP) and renal injury in females, as seen in polycystic ovary syndrome females. However, it is not clear whether treatment with gender-affirming hormonal therapy (GAHT) in trans-men have an impact on their BP and renal health as adults and with aging. Therefore, the present study was undertaken to test the hypothesis that chronic androgen supplements (starting post-pubertal, model of GAHT) in female-to-male trans-sex rats will increase BP and promote renal injury that are exaggerated with aging. Methods: Female SD rats were implanted with testosterone propionate-filled silastic implants (TP, 7.5 mg/10 mm silastic tube/rat, replaced every 3 wks) starting at 7 wks of age (post-pubertal) until 17 months (mos) of age and compared to controls (CON, empty silastic implants). Serum testosterone was measured by LC/MS at 3 mos of age (n=4/grp). Radiotelemetry transmitters were implanted and mean arterial pressure (MAP) was measured at 3 and 17 mos of age (n=3-6/grp). Body composition was determined at 3 and 17 mos of age (n=3-4/grp). Proteinuria was determined at 3, 5 and 7 mos of age (n=4/grp). Serum and urinary creatinine (Cr) were measured at 7 mos of age and Cr clearance was calculated (n=4/grp). Urinary kidney injury molecule-1 (Kim-1) was measured at 12 mos of age (n=3-4/grp). Results: TP had significantly higher serum testosterone compared to CON (6.4 ± 1.5 vs 0.2 ± 0.05 ng/ml; p&lt;0.05). Despite the similar fat mass, lean mass was significantly higher in TP compared to CON starting at 3 mos of age (253.9 ± 6.7 vs 217.7 ± 5.8 g; p&lt;0.05), until 17 mos of age (325.7 ± 15.1 vs 253.5 ± 3.9 g; p&lt;0.05). Proteinuria was significantly higher in TP compared to CON at 5 and 7 mos of age (7.6 ± 1.1 vs 2.4 ± 0.5 mg/24 h and 10.1 ± 1.6 vs 2.4 ± 0.4 mg/24 h, respectively, p&lt;0.05). Cr clearance was significantly lower (0.24 ± 0.03 vs 0.32 ± 0.02 ml/min/100 g, p&lt;0.05) and urinary Kim-1 was significantly higher (6.3 ± 1.5 vs 3.5 ± 0.2 ng/24 h, p&lt;0.05) in TP compared to CON. Importantly, MAP was significantly higher in TP compared to CON starting at 3 mos of age (112 ± 3 vs 106 ± 4 mmHg, p&lt;0.05), with further increases at 17 mos of age (133 ± 1 vs 117 ± 6 mmHg, p&lt;0.05). Conclusion: Post-pubertal testosterone in female sex promotes renal injury and increases BP, independent of adiposity. Aging promotes further increases in BP, suggesting increased risk of cardiovascular diseases. Future studies should determine the mechanisms behind the increase in BP in the female-to-male trans-sex model. P20GM121334, AHA Career Development Award 938320, P20GM104357, R01HL135089, P01HL051971 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Case Series of Ischemic Stroke occurring in Male- to- Female Transgender population on Gender - Affirming Hormonal Therapy and Review of the Literature (P2-5.022)

<h3>Objective:</h3> To stress the importance of individualized vascular risk assessment and shared decision-making to continue Gender-Affirming Hormonal therapy (GAHT) in the Male to Female (MTF) transgender population following ischemic stroke with review of the literature. <h3>Background:</h3> Transgender individuals have higher mental health burden and suicide rates. GAHT is the standard of care for transgender individuals suffering from symptoms of gender dysphoria. Estrogen therapy has been associated with increased stroke risk, but its specific contribution is poorly characterized and appears to be impacted by the route of administration. <h3>Design/Methods:</h3> We include three self-identified MTF transgender patients who had taken GAHT and treated for ischemic stroke inpatient or were seen for stroke follow-up. Data was gathered from chart review including demographics, vascular risk factors, type of GAHT, clinical course, and outcomes. <h3>Results:</h3> Two MTF transgender patients on GAHT were treated inpatient for an acute stroke and one was seen in follow up. At the time of infarct, one MTF transgender patient was on combination hormonal therapy, one patient was on combination hormonal therapy and spironolactone, and one patient was on estrogen hormonal therapy of unknown type. Traditional vascular risk factors were present in the patient population prior to ischemic stroke including: hypertension, hyperlipidemia, type 2 diabetes mellitus, morbid obesity, prior ischemic stroke, tobacco use disorder, alcohol use disorder. <h3>Conclusions:</h3> Each patient in our small series had traditional vascular risk factors in addition to GAHT use prior to ischemic infarct. Identifying and treating comorbid vascular risk factors in MTF transgender patients prior to and during GAHT is essential to decrease ischemic stroke risk. Additional studies are needed to determine the relative impact of GAHT on stroke risk. Given mental health burden of gender dysphoria symptoms, shared decision-making is necessary to determine risks and benefits of continuing GAHT after ischemic stroke in MTF transgender patients. <b>Disclosure:</b> Ms. Giovannini has nothing to disclose. An immediate family member of Dr. Ivan has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Cellular and Molecular Medicine. An immediate family member of Dr. Ivan has received intellectual property interests from a discovery or technology relating to health care. Dr. Karel has nothing to disclose.

MP54-17 FERTILITY PRESERVATION RATES AMONG TRANSGENDER GIRLS IN A MULTIDISCIPLINARY TRANSGENDER PROGRAM

You have accessJournal of UrologyCME1 Apr 2023MP54-17 FERTILITY PRESERVATION RATES AMONG TRANSGENDER GIRLS IN A MULTIDISCIPLINARY TRANSGENDER PROGRAM Nir Tomer, Eva Baldisserotto, Alexandra Siegal, Benjamin Eilender, Erin Miller, Mabel Yau, Matthew Oransky, Joshua Safer, and Neha Malhotra Nir TomerNir Tomer More articles by this author , Eva BaldisserottoEva Baldisserotto More articles by this author , Alexandra SiegalAlexandra Siegal More articles by this author , Benjamin EilenderBenjamin Eilender More articles by this author , Erin MillerErin Miller More articles by this author , Mabel YauMabel Yau More articles by this author , Matthew OranskyMatthew Oransky More articles by this author , Joshua SaferJoshua Safer More articles by this author , and Neha MalhotraNeha Malhotra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fertility preservation (FP) should be an important step in health care prior to initiating gender affirming hormonal therapy (GAHT) or puberty blockade in transgender and gender diverse (TGD) people. However, FP is often not integrated into comprehensive gender affirming care. Prior studies show low rates of FP in transgender youth. The aim of this study was to understand how the integration of a pediatric urology team into our Center for Transgender Medicine and Surgery program would impact the overall number of transgender girls who pursue fertility preservation. METHODS: To assess the success of fertility preservation, we performed a retrospective review of a database of all TGD patients who were 18 years or younger with testes, and sought GAHT. Patients were evaluated and followed in our Center for Transgender Medicine and Surgery from 4/2022 through 10/2022. Demographics, age, hormonal treatment, Tanner stages, and FP use were recorded from the medical record. Successful sperm banking was defined as freezing >1 vial of sperm. RESULTS: Twenty seven patients ranging from ages 10-17 years old were referred to pediatric urology for FP. Of patients referred to the clinic, 20 (74.1%) were interested in pursuing/are in the process of sperm banking. Of the patients who didn’t pursue FP, 1 (3.7%) of the patients were prepubertal (Tanner I), 4 (14.8 %) patients declined to attempt FP because they wanted to avoid masturbation, and 2 (7.4%) patients declined referral altogether. Twelve patients began the process of FP with sperm banking - ten of whom successfully froze sperm within WHO reference ranges of semen parameters and 2 children were azoospermic. Upon review, these 2 patients with azoospermia were found to already have started hormonal suppression. CONCLUSIONS: Our data suggest that a large percentage of patients may be interested in fertility preservation. The integration of a pediatric urology team can help to increase access to this service. Importantly, that the children who already started pubertal suppression were azoospermic highlights the importance of the integration of pediatric urology and FP into the health care process prior to pubertal suppression therapy. In our program, counseling on GAHT and puberty blockers’ impact on fertility is introduced early and pediatric urology consultation is offered concurrently or even prior to endocrinology consultation. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e760 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nir Tomer More articles by this author Eva Baldisserotto More articles by this author Alexandra Siegal More articles by this author Benjamin Eilender More articles by this author Erin Miller More articles by this author Mabel Yau More articles by this author Matthew Oransky More articles by this author Joshua Safer More articles by this author Neha Malhotra More articles by this author Expand All Advertisement PDF downloadLoading ...

Gender-affirming hormonal therapy for transgender and gender-diverse people-A narrative review.

As the number of transgender and gender-diverse (TGD) people accessing gender-affirming care increases, the need for healthcare professionals (HCPs) providing gender-affirming hormonal therapy (GAHT) also increases. This chapter provides an overview of the HCPs interested in getting involved in providing GAHT.

Characteristics and gender affirming healthcare needs of transgender and non-binary students starting hormone therapy in a student health service in Aotearoa New Zealand.

Introduction Traditionally, gender-affirming hormonal therapy (GAHT) is initiated in secondary care, but a primary care based approach has been developed to reduce access barriers. Aim We aim to describe the demographics, hormone choices, and additional referrals made for young people initiating GAHT in a primary care setting in Aotearoa New Zealand. Methods Clinical notes were reviewed for all patients who commenced GAHT between 1 July 2020 to the end of 2022 at a tertiary education health service. Data were collected on age, ethnicity, gender, type of hormones prescribed, and any additional referrals. Results Eighty five patients commenced GAHT during the review period (64% assigned male at birth and starting oestrogen-based GAHT, 36% assigned female at birth and commencing testosterone-based GAHT). Fourty seven percent of patients identified as transgender female, 38% as non-binary, and 15% as transgender male. Spironolactone was the most common choice of testosterone blocker (81%). The choice of oestrogen formulation was fairly equal between patches (54%) and tablets (46%). Eighty percent of those assigned male at birth chose to preserve fertility, 54% requested voice therapy, and 87% of those assigned female at birth requested top surgery. Discussion There is a need for improved understanding of non-binary gender-affirmation needs, in particular those of Māori and Pasifika youth. An informed consent approach in primary care can reduce barriers and distress for transgender youth seeking GAHT. The high unmet need for top surgery for transgender people assigned female at birth requires attention.

Study of Effects of Gender-Affirming Hormone Therapy on Bone Mineral Density in Individuals with Gender Dysphoria.

Gender affirming hormone therapy (GAHT) is the mainstay treatment in transitioning individuals and has positive physical and psychological effects. Among the things to monitor in transgender patients on long-term hormones, bone health is an essential consideration. As the calcium intake in the Indian population is less, and many gender-incongruent individuals may not take adequate calcium in their diet, we needed data on the bone health of Indians with gender dysphoria as the information available globally may not apply to our population. The study was performed to assess bone mineral density in individuals with gender dysphoria who were on gender-affirming hormonal therapy for at least 6 months. It was a hospital-based cross-sectional study of bone mineral density measured at two sites - hip and spine in individuals with gender dysphoria on GAHT for at least six months. A total of 30 individuals were included in this study. The mean age of individuals with Gender dysphoria was found to be 28.17 ± 6.15 years, and the age range was 19-42 years. Out of the 30 individuals, 14 were transgender males, and the remaining 16 were transgender females. Bone mineral density at the hip and spine in transgender males was 1.047 ± 0.124 g/cm2 and 1.065 ± 0.115 g/cm2, which was better compared to transgender females in whom the bone mineral density at hip and spine was 0.899 ± 0.873 g/cm2 and 0.854 ± 0.099 g/cm2 (P = 0.001 for hip; P = 0.000 for spine). The Z score at hip and spine were better in transgender males as compared to transgender females (P < 0.001 for hip; P < 0.001 for spine) when compared to genetic sex and at the spine (P = 0.001) when compared to affirmed sex. In this study, we observed that the transgender females who underwent orchidectomy had a lower mean Z score at spine compared to individuals who did not undergo the procedure. The current study results indicate that GAHT does have positive effects on bone health in transmen.

PS-BPC11-5: INCIDENCE OF CLINICAL HYPERTENSION IN YOUNG TRANSGENDER PEOPLE AFTER A FIVE-YEAR FOLLOW-UP: ASSOCIATION WITH GENDER-AFFIRMING HORMONAL THERAPY

Introduction and Objective: There is a paucity of data on the long-term cardiovascular side effects of hormonal therapy in transgender people. The most overlooked issue is the cardiovascular risk associated with the use of androgen blockers. While some short-term data on blood pressure effects of gender-affirming hormonal therapy are available, the risk of hypertension development is unknown. We sought to assess this risk in our transgender patients. Design and Methods: Retrospective analysis of the clinical records of consecutive transgender patients who began hormonal therapy in our Outpatient Gender Identity Clinic with &lt; 30 years of age and have a follow-up of at least 5 years. Patients who had office sitting BP &gt; 140/90 mmHg at least twice, had an ABPM or systematic HBPM register with &gt; 135/85 mmHg or were taking antihypertensive medication were diagnosed with hypertension. Mediation analyses with weight increase as mediator were performed post-hoc to quantify its relative contribution to the increase in blood pressure. Patients who were already living with hypertension at the onset of hormonal therapy, withdrew from it or switched androgen blockers were excluded. All subjects gave informed consent. Results: 129 transgender women treated with estradiol and 153 transgender men treated with testosterone were included. Their onset and 5-year follow-up age, blood pressure and body weight are shown in the Table (women are stratified by type of androgen blocker) along with the incidence of hypertension. The increase in body weight was strongly correlated with the SBP increase (Spearman's r: 0.361, p &lt; 0.001). Mediation analyses showed that 31.2% - 42.3% (95% CI) of the SBP increase was mediated by body weight increase but the rest was body weight-independent. Conclusions: The annual incidence of hypertension in young transgender men (1.17%) seems comparable to that of the general population, but in young transgender women the choice of androgen blocker has a remarkable effect on the incidence of hypertension, with apparent protective effect of spironolactone but a striking risk increase with cyproterone acetate (close to 5% yearly). Taken together with the known risks of this drug (meningioma, depression, low libido, liver toxicity, thrombosis…), the use of cyproterone acetate for this indication should be reconsidered. Body weight increase is undoubtedly related to the increase of BP transgender people on gender-affirming hormone therapy but is probably not the main factor.

Abstract 14489: Non-ST-Elevation Myocardial Infarction in a Transgender Woman: A Case Report and Perspective Into an Emerging High-Risk Population

Clinical Case: A 37-year-old transgender (TG) woman off gender-affirming hormonal therapy (GAHT) presented with substernal chest pain radiating to the left arm, worse with exertion and relieved with res. She was hypertensive and tachycardic on admission. Initial bloodwork revealed an elevated troponin I of 0.57 ng/mL, which peaked at 1.48 ng/mL. EKG on admission showed hyperacute T waves in the anterior leads without ST elevation (see Figure 1). She was diagnosed with non-ST elevation myocardial infarction (NSTEMI) and taken for left heart catheterization (LHC). Decision-Making: TTE showed preserved LVEF and basal inferior, basal inferolateral, basal anterolateral and mid-anterolateral hypokinesis. LHC showed proximal-to-mid right coronary artery (RCA) occlusion. After failed aspiration thrombectomy indicating calcified plaque, two overlapping drug-eluting stents (DES) were successfully deployed with restoration of flow. She was discharged home on aspirin, ticagrelor, atorvastatin, and carvedilol. Discussion: Despite a recent push to increase awareness, research and healthcare equality specific to lesbian, gay, bisexual, transgender, and queer (LGBTQ+) patients, a significant gap persists. Specifically, stress, inflammation, dyslipidemia, and thromboembolism predispose this understudied population to increased coronary artery disease (CAD) and myocardial infarction (MI). Accordingly, greater effort needs to be taken to mitigate preventable cardiac morbidity and mortality in this patient population. Conclusion: CAD in LGBTQ+ adults is well studied. However, there are few published studies on CAD specifically among TG men and women. National cross-sectional data highlights this disproportionate risk of CAD and MI among TG men and women relative to their cisgender female and male peers, a healthcare disparity recently emphasized by the AHA. Consequently, care must be taken to eliminate these aforementioned inequalities.