Hormone Therapy Prescription Research Articles

Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients.

Purpose: Sex differences in cardiac arrhythmias are well established. This study aimed to explore the prevalence of arrhythmias in transgender and nonbinary (TGNB) adults. Methods: This cross-sectional study utilized electronic medical records from a center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups: TGNB (transgender men, transgender women, nonbinary [NB]-assigned male at birth, NB-assigned female at birth), cisgender men, and cisgender women. The primary outcome was any arrhythmia using age- and race-adjusted regression models comparing transgender patients with cisgender men and cisgender women. Prevalence of arrhythmias was explored in transgender people with a gender-affirming hormone therapy (GAHT) prescription. Results: The sample included 49,862 adults, with 7121 (14%) TGNB persons. Median age was 28 years. Prevalence of arrhythmias was low (0.7-1.4% NB persons, 1.4-1.5% transgender persons). After adjustment, transgender women and transgender men had similar odds of any arrhythmia compared with cisgender men (transgender women: adjusted odds ratio [aOR] 0.89, 95% confidence interval [CI] 0.63-1.24, p = 0.52; transgender men: aOR 1.17, 95% CI 0.82-1.62, p = 0.37), but higher odds of any arrhythmia compared with cisgender women (transgender women: aOR 1.65, 95% CI 1.13-2.34, p = 0.01; transgender men: aOR 2.15, 95% CI 1.48-3.04, p < 0.001). Prevalence of arrhythmias appeared similar among transgender adults regardless of GAHT use (transgender men: 1.5% vs 1.9%, transgender women: 1.2% vs 2.1%). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.

Use of Telemedicine Services Is Associated with Longer ime to TInitiation of Hormone Therapy in Transgender Teens and Young Adults.

Purpose: This is a retrospective chart review examining factors, which may contribute to timing of receipt of prescription for testosterone or estrogen-based interventions for transgender adolescents and young adults who do not receive such a prescription at their first medical appointment. Methods: A total of 176 patient records were available; of this a minority received a prescription for hormone therapy at first medical appointment. Of the remaining 108 unique individuals, 49 received a prescription at a subsequent medical. Results: Participants seen through virtual health care had a significantly longer time in care prior to receipt of estrogen or testosterone prescription (331 days vs. 220 days, p = 0.046). No other significant relationships were found. Conclusion: Patients who utilize telemedicine services for gender-related health care purposes and who did not receive a prescription for estrogen or testosterone at their initial medical encounter have a longer lead time to receipt of hormone therapy.

Mental Health Diagnoses and Suicidality Among Transgender Youth in Hospital Settings.

Purpose: The purpose of this analysis is to: 1) describe the most common mental health diagnoses in the emergency department (ED) and inpatient hospital settings among transgender and gender diverse (TGD) youth vs. matched controls and 2) evaluate if a gender-affirming hormone therapy (GAHT) or gonadotropin-releasing hormone agonist (GnRHa) prescription decreased the risk of suicidality within these settings. Methods: Using the PEDSnet dataset (years 2009-2019), TGD youth aged 8-18 (n = 3414, with a median age at last visit of 16.2 [14.4, 17.7] years, were propensity-score matched to controls (n = 13,628, age 16.6 [14.2, 18.3] years). Relative risks of the most common mental health diagnoses within ED and inpatient settings were calculated for TGD youth compared with controls. Recurrent time-to-event analysis was used to examine whether GAHT or GnRHa attenuated the risk of suicidality among subsamples of TGD youth. Results: TGD youth had a higher relative risk (95% confidence interval [CI]) of mental health diagnoses and suicidality in the ED (5.46 [4.71-6.33]) and inpatient settings (6.61 [5.28-8.28]) than matched controls. TGD youth prescribed GAHT had a 43.6% lower risk of suicidality (hazard ratio [HR] = 0.564 [95% CI 0.36-0.89]) compared with those never prescribed GAHT during our study period or before GAHT initiation. TGD youth who were prescribed GnRHa therapy had a nonstatistically significant reduction in ED or inpatient suicidality diagnoses compared with those never prescribed GnRHa (HR = 0.79 [0.47-1.31]). Conclusion: Although risk of mental health diagnoses and suicidality in ED and inpatient settings was high among TGD youth, a GAHT prescription was associated with a significant reduction in suicidality risk.

Barriers to quality healthcare among transgender and gender nonconforming adults.

To determine the barriers transgender and gender nonconforming (TGNC) adults face when accessing or receiving healthcare in the United States. Primary data were collected between September 2022 and March 2023 from a purposive sample of TGNC adults (N = 116 participants) using an online survey with a series of open-ended and closed-ended questions. Thematic analysis was employed to extract and analyze participants' responses to an open-ended question about challenges they experienced when accessing or receiving healthcare. Two members of the research team conducted qualitative data analyses using Dedoose. The quality of each analysis was subsequently reviewed by a third research team member. Data were collected from responses to one open-ended question that asked about participants' healthcare barriers as a TGNC individual. Five main themes surrounding healthcare barriers emerged from the content analysis: (1) acceptability, (2) accommodation, (3) affordability, (4) availability, and (5) accessibility. First, participants who noted acceptability issues reported explicit discriminatory treatment from providers, providers not using their chosen names and pronouns (e.g., misgendering), and provider refusal to provide gender-affirming care. Second, participants who experienced accommodation challenges identified provider medical training gaps on TGNC patient needs and administrative barriers to care. Third, participants explained affordability issues due to a lack of adequate health insurance coverage. Fourth, participants described availability challenges with accessing hormone therapy prescriptions. Finally, participants noted accessibility issues with obtaining TGNC-specific care at LGBTQ+-affirming clinics. There is a growing interest in the needs of TGNC adults within healthcare settings. This requires that health policies are enacted to ensure that TGNC adults have access to healthcare that is accommodating and accepting/affirming. Study findings may provide insight into the potential impact of current legislation on transgender access and availability.

(081) ACCESSIBILITY AND PRESCRIBING PATTERNS OF HORMONE THERAPIES AMONGST ISSWSH PROVIDERS

Abstract Introduction Vaginal estrogen is a common topical therapy used to treat vulvovaginal disorders and genitourinary syndrome of menopause (GSM). Systemic hormone replacement therapy (HRT) is an evidence based treatment for menopause and female sexual dysfunction. Insurance coverage for topical estrogen and HRT is highly variable and may be inaccessible for many patients. Compounded medications are an alternative that some prescribers turn to despite inconsistency in quality, safety, and prices. Objective To examine prescribing patterns of ISSWSH providers of various hormonal and non-hormonal topical therapies, HRT, and strategies of increasing patient access to these medications. Methods A fourteen-item survey was distributed to ISSWSH providers via online platforms including social media. Participants were asked about medical education background and specialty, practice location, topical hormone replacement therapy (i.e., estrogen, estrogen and testosterone) and non-hormonal therapy (i.e., capsaicin, gabapentin) prescription practices, the most common diagnoses for which they prescribe these medications, systemic hormone therapy prescription practices, and counseling on cost-saving programs. All data was de-identified prior to analysis. Descriptive statistics were performed in SPSS. Results Fifty-five responses were collected. Of these, a majority of participants (51%) are ob-gyn providers and 22% are urology providers. The remaining participants are providers of internal medicine, family medicine, midwifery, urogynecology, and functional medicine. A majority are designated MD, DO, or equivalent (49%) and 45.5% are advanced practice providers (NP or PA). Interestingly, 100% of participating family medicine providers (n=8) report prescribing estrogen-containing systemic therapies, compared to ob-gyns (89%) and urologists (58%). Systemic testosterone was prescribed most often by urologists. Numerous providers report prescribing topical estrogen and testosterone: 50% being family medicine, 67% urologists, 67% midwives, 71% ob-gyns, and 100% of urogynecologists. Prescribing patterns for non-hormonal topicals vary. Gabapentin and valium appear to be most common in ob-gyn practices (43% each). Valium is also commonly prescribed by urologists, family medicine providers, and urogynecologists. According to the results, internal medicine providers rarely prescribe non-hormonal options. Additionally, our data reveals that 91% of participants report counseling patients on cost-saving programs like GoodRx, Mark Cuban Cost Plus Drugs, and others. Conclusions In conclusion, topical and systemic hormone therapies are prescribed at high rates by family medicine, ob-gyn, urogynecology, and urology providers within the ISSWSH community. However, the types of therapies prescribed vary greatly. Counseling regarding cost-saving methods shows to be promising, suggesting that patients are receiving these therapies at the most affordable rate. Further examination of pharmacy-level practices, patient refill trends, and direct medication costs will help to better describe and address patients’ barriers in acquiring treatment options. Disclosure No.

Breast cancer risk assessment for prescription of menopausal hormone therapy in women with a family history of breast cancer: an epidemiological modelling study.

Menopausal hormone therapy (MHT) can alleviate menopausal symptoms but has been associated with an increased risk of breast cancer. MHT prescription should be preceded by individualised risk/benefit evaluation; however, data outlining the impact of family history alongside different MHT therapeutic approaches are lacking. To quantify the risks associated with MHT use in women with varying breast cancer family histories of developing and dying from breast cancer. An epidemiological modelling study for women in England using the BOADICEA breast cancer prediction model and data relating to MHT use and breast cancer risk taken from research by the Collaborative Group on Hormonal Factors in Breast Cancer. The risk of developing and dying from breast cancer between the ages of 50 and 80 years was modelled in women with four different breast cancer family history profiles: 'average', 'modest', 'intermediate', and 'strong' by using 1) background risks of breast cancer by age and family history, 2) relative risks for breast cancer associated with MHT use, and 3) 10-year breast cancer-specific net mortality rates. This study modelled use of combined oestrogen-progestogen MHT (cyclical or continuous) and oestrogen-only MHT. For a woman of 'average' family history taking no MHT, the cumulative breast cancer risk (age 50-80 years) is 9.8%, and the risk of dying from the breast cancer is 1.7%. In this model, 5 years' exposure to combined-cyclical MHT (age 50-55 years) was calculated to increase these risks to 11.0% and 1.8%, respectively. For a woman with a 'strong' family history taking no MHT, the cumulative breast cancer risk is 19.6% (age 50-80 years), and the risk of dying from the breast cancer is 3.2%. With 5 years' exposure to MHT (age 50-55 years), this model showed that these risks increase to 22.4% and 3.5%, respectively. In this model, both family history and MHT are associated with increased risk of breast cancer. Estimates of the risks of breast cancer associated with MHT for women with different family histories can be used to support decision making around MHT prescription for women experiencing menopausal symptoms.

Abstract PO5-02-04: Irish National Analysis of the Clinical and Economic impact of 21-gene Oncotype DX® testing in Early-Stage, 1-3 lymph node positive, Hormone Receptor positive (HR+), HER2-Negative (HER2-), Breast Cancer (BC)

Abstract PO5-02-04: Irish National Analysis of the Clinical and Economic impact of 21-gene Oncotype DX® testing in Early-Stage, 1-3 lymph node positive, Hormone Receptor positive (HR+), HER2-Negative (HER2-), Breast Cancer (BC)

Индивидуализация гормональной терапии: междисциплинарный подход

Тoday, clinicians deal with many practical issues when prescribing menopausal or hormone replacement therapy. The main goal of the expert workshop was to discuss the principles of prescribing hormone therapy to patients of various age groups with various gynecological and somatic disorders and comorbidities, to determine the tactics for selection of the type of therapy based on the personalization principles.

Menopause hormone therapy prescribing in ambulatory care visits among midlife and older U.S. women from 2018 to 2019

The rates of prescription for menopause hormone therapy have been low in the U.S. since the 2002 Women's Health Initiative study, but no recent studies have assessed the prescribing of hormone therapy in the U.S. Using the National Ambulatory Medical Care Survey data from 2018 to 2019, we found that hormone therapy was prescribed in 3.8 % of U.S. visits by midlife and older women, with 60 % of these visits including estradiol-only prescriptions. Older age and Hispanic/Latina ethnicity were associated with decreased odds of prescribing, while White race and depression were associated with increased odds, indicating possible disparities in menopause care.

Psychometric validation of the 15-item Patient Health Questionnaire – Anxiety and Depression Scale (PHQ-ADS) to assess psychological distress in breast cancer survivors

ObjectivePsychological distress persists amongst breast cancer survivors, so reliable assessment of symptoms is essential. The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) is a composite measure of depression and anxiety and has been used to measure distress. This study aimed to evaluate the psychometric properties of the PHQ-ADS within breast cancer survivors. MethodBreast cancer survivors (N = 280) were recruited online and followed up at 12-months. Depression (PHQ-8) and anxiety (GAD-7) items formed the composite PHQ-ADS score. Additional measures included: distress thermometer (convergent validity), fear of cancer recurrence and COVID distress (discriminant validity), and self-compassion (predictive validity). Confirmatory factor analysis (CFA) using weighted least squares mean and variance adjusted estimation was undertaken. ResultsOne, two, and bifactor models underlying the PHQ-ADS were evaluated. The bifactor model had the most appropriate model fit overall. Omega hierarchical for the general distress factor was 0.914, accounting for 82% of explained variance. This suggests the PHQ-ADS is sufficiently unidimensional to warrant use of a total composite score. The PHQ-ADS demonstrated strong convergent and moderate discriminant validity. Self-compassion was an independent predictor of distress at 12-months. ConclusionsThe PHQ-ADS is a valid measure for psychological distress in breast cancer survivors prescribed hormone therapy.

Does hormone therapy exacerbate other venous thromboembolism risk factors?

Postmenopausal symptoms in women at higher risk for venous thromboembolism (VTE) due to comorbidities are often undertreated because of concerns that hormone therapy (HT) may increase VTE risk; however, it is unclear how much HT impacts risk of VTE when compared with other risk factors. This is a case-control study in a commercial claims database from 2007 to 2019. Women aged 50 to 64 years (n = 223,949) were classified as cases if they had an International Classification of Diseases code indicating an acute VTE plus a filled prescription for an anticoagulant, placement of intravascular vena cava filter, or death within 30 days of diagnosis. Controls were matched 10:1 to each case by index date and age. Risk factors and comorbidities present within the year before index were examined. Exposure was defined as a HT prescription within 60 days before index. There were 20,359 VTE cases and 203,590 matched controls. A conditional logistic regression indicated that the greatest risks for VTE were from metastatic cancer (odds ratio [OR], 13.66; 95% CI, 12.64-14.75), hospitalization/surgery (OR, 8.51; 95% CI, 8.09-8.96), trauma (OR, 3.52; 95% CI, 3.32-3.73), comorbidity burden (OR, 3.51; 95% CI, 3.34-3.69), history of hypercoagulable condition (OR, 3.10; 95% CI, 2.87-3.36), and varicose veins (OR, 2.87; 95% CI, 2.56-3.22). Regarding hormone exposure, we observed ORs of 1.51 (95% CI, 1.43-1.60) for any recent hormone exposure; 1.13 (95% CI, 1.04-1.23; number needed to harm, 4,274) for unopposed estrogen menopausal HT; 1.23 (95% CI, 1.10-1.38; number needed to harm, 2,440) for combined menopausal HT; and 5.22 (95% CI, 4.67-5.84) for combined hormonal contraceptives compared with no recent HT exposure. Hormone therapy exposure did not appear to adversely influence other risk factors, and exposure generally played a minor role in VTE risk. Contraceptives, however, were a strong risk factor.

Evaluation of services provided in a gender health clinic

BackgroundTransgender and gender diverse (TGD) individuals face discrimination and mistreatment in healthcare spaces, resulting in poor health. The Mountain Area Health Education Center (MAHEC) Gender Health Clinic was launched in September of 2022 to meet the healthcare needs of TGD patients. ObjectiveDescribe services provided in and patient satisfaction with an interdisciplinary Gender Health Clinic serving TGD patients. Practice DescriptionThe Gender Health Clinic is a subspecialty clinic of the MAHEC Family Health Center in Asheville, North Carolina. The clinic offers interdisciplinary services to TGD patients, including primary care, gynecology, and medication management. Practice InnovationThe interdisciplinary clinic team was assembled to create a safe environment for TGD patients to receive medical care. The pharmacy team facilitated provider training, consolidated clinical references, and provided comprehensive patient education on hormone therapy. Evaluation MethodsA quantitative description of services and patient demographic information was evaluated through a retrospective chart review of the first six months of the clinic. Patient satisfaction was evaluated through anonymous questionnaires. ResultsForty-four patient encounters were evaluated for 23 unique patients. The mean age was 26.6 years, and 65.2% of patients were assigned female at birth. Gender identities were distributed across male (39.1%), female (34.8%), and non-conforming (26.1%). Nearly all patients (97.7%) received documented general education from any provider. Most patients (79.6%) received prescriptions for hormone therapy. More than one-third (38.7%) of patients had a documented pharmacist interaction. Twenty-one questionnaires were completed out of 23 unique patients. All respondents rated their overall experience as “Excellent” or “Very Good.” Highly rated positive clinical interactions included courteous clinical staff (4.9) and having needs met (4.8). Ease of scheduling an appointment (4.3) was rated lowest among all questionnaire items. ConclusionThe positive patient experiences and level of services provided suggest a promising start to MAHEC’s Gender Health Clinic.

Abstract B141: Predictors of prescription and self-reported use of endocrine therapy among hormone receptor positive breast cancer survivors in the Detroit Research on Cancer Survivors cohort

Abstract Black women with hormone receptor (HR) positive (+) breast cancer are twice as likely to have weakly HR+ tumors (1-10% of tumor cells staining positive for HR) compared to White women, and women with weakly HR+ tumors are 60% more likely to die from their breast cancer compared to those with strongly HR+ tumors (&amp;gt;10% of tumor cells staining positive for HR). While all women with HR+ breast cancer are recommended to receive endocrine therapy (ET) regardless of the strength of HR positivity, we have also shown that women with weakly HR+ tumors are 20% less likely to receive ET compared to women with strongly HR+ tumors. The goal of this analysis was to better understand the multi-level factors associated with prescription and self-reported use of ET among Black women with HR+ breast cancer. We used questionnaire data from 922 Detroit Research on Cancer Survivors (ROCS) participants with HR+ breast cancer to evaluate demographics, socioeconomic status, health status, tumor characteristics, treatment, treating oncologist characteristics, and treating hospital characteristics as predictors of oncologists’ intent to prescribe ET as well as self-reported use of ET. Intent to prescribe ET was defined as any evidence of ET prescription regardless of whether patients refused or had contraindications. Odds ratios were calculated using mixed-effects logistic regression models to account for group-level oncologist and hospital effects in single and multivariable analyses. Oncologists intended to prescribe ET for 83.4% (n=769) of participants, and 30.2% (n=232) of these participants reported ever having received ET to treat their breast cancer. Accounting for 6.7% of participants, patients with weakly HR+ tumors were 16-fold (p&amp;lt;0.001) more likely to be prescribed ET in the multivariable model. Other significant predictors included BMI of less than 25 kg/m2 (OR=2.12, p=0.0053) or at least 30 kg/m2 (OR=2.39, p=0.032) compared to BMI &amp;lt;25 kg/m2, &amp;gt;10% HR vs. 1-10% HR (OR=2.19, p=0.0056), having an OncotypeDx test performed (OR=2.19, p=0.0056), and receiving radiation (OR=2.27, p=0.0015). Among participants who were prescribed ET, self-reported use of ET was associated with more recent year of diagnosis (OR=1.34, p&amp;lt;0.001), completing at least a high school education (OR=2.87, p=0.025), higher health literacy (OR=1.27, p=0.013), distant stage at diagnosis (OR=3.16, p=0.041), and not having undergone surgery (OR=9.54, p=&amp;lt;0.001). While physician- and hospital-characteristics such as oncologist gender and hospital size were associated with ET use and prescription in single variables models, these did not remain significant in multivariable models. We will continue to explore factors associated with longitudinal ET adherence using data from yearly follow-up questionnaires. Identification of the distinct sets of clinical and patient-level factors associated with prescription versus self-reported use of ET will help to inform the development of multilevel interventions to increase uptake of ET and ultimately improve survival among Black women with HR+ breast cancer. Citation Format: Kristen S. Purrington, Hadeel Assad, Julie J. Ruterbusch, Ann G. Schwartz, Seongho Kim, Lauren Hamel. Predictors of prescription and self-reported use of endocrine therapy among hormone receptor positive breast cancer survivors in the Detroit Research on Cancer Survivors cohort [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B141.

Abstract 14018: Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients

Background: Sex differences in cardiac arrhythmias are well-established and partly attributed to sex hormones. Aim: We aimed to explore the prevalence of arrhythmias in transgender and nonbinary ( TGNB ) adults. Methods: This cross-sectional study utilized patient electronic medical records from a single community healthcare center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups as TGNB (transgender man[TGM], transgender woman[TGW], nonbinary-assigned male at birth, nonbinary-assigned female at birth) and cisgender (cisgender man[CisM] or cisgender woman[CisW]). We categorized arrhythmias as atrial, ventricular, or other. Descriptive statistics characterized the prevalence of arrhythmias by gender group. Age- and race-adjusted Firth-type logistic regression models compared TGNB patients to CisM and CisW. The prevalence of arrhythmias was also descriptively explored in nonbinary people and in TGNB people with a gender-affirming hormone therapy (GAHT) prescription. Results: Among 49,862 adults, 7121 (14%) identified as TGNB persons. Participants were young (median age 28 years-old) and prevalence of arrhythmias was low (0.7-1.4% in nonbinary persons, 1.4-1.5% in transgender persons). Adjusting for age and race, TGM and TGW had a similar risk of arrhythmias compared to CisM (TGW: OR=0.89 (0.63-1.24), p=0.52; TGM: OR=1.17 (0.82-1.62), p=0.37), but statistically significantly higher odds of arrhythmias compared to CisW (TGW: OR=1.65 (1.13-2.34), p=0.01; TGM: OR=2.15 (1.48-3.04), p&lt;0.01). Prevalence of arrhythmias appeared similar among TGNB adults who used GAHT and those who did not (1.5% vs 1.9% in TGM, 1.2% vs 2.1% in TGW). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.

Роль менопаузальной гормональной терапии в вопросах профилактики сердечно-сосудистых заболеваний у женщин в пострепродуктивном периоде

Cardiovascular disorders (CVD) in female population are the main cause of mortality, and an increase in the prevalence of myocardial infarction among women is observed in the recent decades, in contrast to the male population showing a decrease in this indicator. Certainly, the mechanisms underlying CVD in people of different sexes have much in common, however, one cannot ignore the differences associated with fundamental genetic determinants of ageing, different characteristics of metabolism and fundamentally different types of hormonal status. It has been found that realization of activity of sex hormones is among major factors ensuring protection against cardiovascular disorders in premenopausal women. The increase in the rate of cardiovascular disorders and the lack of menopausal hormone therapy (MHT) prescription to women in their post-reproductive stage may be partially correlated. Aim. To analyze the data provided by advanced scientific research focused on prescription of menopausal hormone therapy (MHT) aimed at preventing cardiovascular disorders in the post-reproductive period. Methods. Analytical review of domestic and foreign papers on the topic, including using PubMed, Elseviewer, Cochrane library, Elibrary databases. Conclusions. Despite the fact that the issue of prevention and treatment of cardiovascular disorders attracts particular attention of global healthcare, CVDs still rank first in the world as the cause of deaths. In menopausal women, hypoestrogenism is among major pathogenetic links of cardiac abnormalities. To increase adherence of peri- and postmenopausal women to early diagnosis, general practitioners should give due consideration to referral of such women to obstetricians-gynecologists for timely correction of estrogen deficiency. It is also necessary to further study the issue in order to identify early diagnostic predictors of cardiovascular disorders.

Menopausal transition. Is it possible to delay the prescription of menopausal hormone therapy?

After the end of the reproductive period, women spend a third of their lives in menopause. During this period, they experience a range of predictable symptoms and conditions associated with changing levels of sex hormones and aging of the body. The menopausal transition precedes menopause by several years and is usually characterized by irregular menstrual cycles, hot flashes and night sweats. After menopause, genitourinary symptoms predominate, including vulvovaginal atrophy and dryness and complaints associated with urinary disturbances: increased urinary frequency, urgency, and nocturia. Menopausal hormone therapy is effective for vasomotor and genitourinary symptoms, but it is associated with the development of cardiovascular risks, cognitive impairment, depression, and a number of side effects. An alternative in the therapy of menopausal symptoms can be the prescription of biologically active supplement Happyclim®. The complex composition of the drug effectively fills the lack of its own estrogen in the female body. The preparation Happyclim® contains phytoestrogens (soy isoflavones, flavonoids) and auxiliary components (magnesium and B vitamins, vitamin C, extract of medicinal melissa), which with high efficiency affect the woman’s body during menopausal transition, alleviating the symptoms of menopause and improving the quality of life. This article presents a cross-section of the literature on the use of phytoestrogens and the dietary supplement Happyclim® during the perimenopausal transition to delay the administration of menopausal hormone therapy.

SAT401 The Aftermath Of Pueraria mirifica: A Case Of Hypertriglyceridemia And Necrotizing Pancreatitis In A Non-binary Individual With Surreptitious Use Of Oral Estrogenic Compounds

Abstract Disclosure: S. Tobolsky: None. F.J. Hayes: None. J. Lo: None. Background Prescription of gender-affirming hormone therapy (GAHT) has become an increasingly prevalent aspect of endocrine care meriting greater attention from our specialty. We report a case where surreptitious use of an unregulated compound with estrogenic activity in a patient with gender dysphoria resulted in severe hypertriglyceridemia and necrotizing pancreatitis. The compound, Pueraria mirifica, is readily available for purchase online. CaseThe patient is a 26yo non-binary individual assigned male at birth who presented to the ED with 1.5 days of abdominal pain and vomiting. CT abdomen showed acute necrotizing pancreatitis. On arrival, serum triglycerides 2,559 mg/dl (nl 40-150 mg/dL) and lipase 481U/L (nl 13-60 U/l). The patient reported no alcohol use. Family history of unspecified hyperlipidemia in father. Patient was admitted, made NPO, and started on insulin/dextrose infusions, continued until serum triglycerides dropped to &amp;lt;1,000 mg/dL. Fenofibrate started and extensive nutritional counseling on low-carbohydrate and low-fat diet given. In absence of clear etiology for hypertriglyceridemia, patient was questioned carefully on supplement use and revealed they took 2 tablets of Pueraria mirifica daily with intent of transitioning without medical guidance given prior negative encounters with healthcare. Patient discharged on fenofibrate 200 mg, atorvastatin 20 mg and omega-3 acid ethyl esters 2 g BID, with plan for endocrinology follow-up for initiation of medically supervised GAHT. At follow-up on this regimen, LDL was 79 mg/dL and triglycerides 160 mg/dL. Goals of transition were discussed with the patient as was importance of avoiding oral estrogens, prescribed or over-the-counter. Given patient’s desire for partial transition, low dose transdermal estradiol 0.05 mg patch and spironolactone 50mg BID started. On above regimen, estradiol was 179 pg/mL and total testosterone suppressed at 72 ng/dL. The patient’s triglycerides remained &amp;lt;150 mg/dL with no further complications. ConclusionThis case highlights a potentially fatal complication of hormone use in a transgender individual with likely underlying familial hypertriglyceridemia. It also illustrates how distrust of the medical system led to surreptitious hormone use and emphasizes the need to create a safe, welcoming environment for individuals with gender dysphoria. Finally, it emphasizes the need to interrogate possible surreptitious hormone use in patients with unusual presentations and for endocrinologists to be aware of the need to avoid oral estrogen use in patients with hypertriglyceridemia. Presentation: Saturday, June 17, 2023

The role of polymorphic variants of the kisspeptin gene in the pathogenesis of ovarian insufficiency in patients with type 1 diabetes mellitus, genital endometriosis and combination of these diseases

BACKGROUND:Type 1 diabetes mellitus and genital endometriosis have a negative impact on female reproductive system. There is an opinion that kisspeptin plays an important role in the pathogenesis of ovarian insufficiency in patients with diabetes and endometriosis.&#x0D; AIM:The aim of this study was to evaluate the role of the kisspeptin gene (KISS1) polymorphism in the pathogenesis of ovarian insufficiency in patients with type 1 diabetes mellitus, genital endometriosis and in women with combination of these diseases.&#x0D; MATERIALS AND METHODS:The allele and genotype frequencies of the polymorphic variants rs5780218 (c.145delT) and rs3924587 (c.89GA) of theKISS1gene were evaluated in 258 women using polymerase chain reaction-restriction fragment length polymorphism technique. This study included 73 patients with type 1 diabetes mellitus, 83 patients with genital endometriosis, 35 patients with combination of type 1 diabetes mellitus and genital endometriosis, and 67 control subjects. The control group is represented by women of the population.&#x0D; RESULTS:The analysis of theKISS1gene showed that incidence rates of type 1 diabetes mellitus, genital endometriosis and combination of these diseases do not differ in the presence of the ins/del, del/del, and ins/ins (rs5780218) genotypes. Thus, the del allele and the ins/del and del/del genotypes are not associated with an increased risk of these diseases. It was found that in patients with type 1 diabetes mellitus, the frequency of normogonadotropic ovarian insufficiency was higher (odds ratio 15.955; 95% confidence interval4,4757,0;p 0.05) in the presence of the G/A genotype according to the polymorphic variant rs3924587 compared to the G/G genotype.&#x0D; CONCLUSIONS:The data obtained allow for explaining the high incidence of ovarian insufficiency in women with type 1 diabetes mellitus. In patients with type 1 diabetes mellitus with the G/A genotype who are planning pregnancy, even in case of regular menstrual cycle, it is advisable to perform hormone blood tests in dynamics for timely diagnosis of ovarian insufficiency and prescription of hormonal therapy.

Justification of the choice of hormone therapy for ovarian cancer

BACKGROUND. Hormonal dependence of ovarian cancer remains a debatable issue in modern oncogynecology. Its decision will allow not only to clarify the pathogenesis of the development of ovarian cancer, its prognosis, but also to substantiate the indications for hormone therapy as a component of complex treatment.&#x0D; OBJECTIVE. To study the experience of domestic and foreign specialists regarding the pathogenetic rationale for prescribing hormone therapy to patients with ovarian cancer and its effectiveness.&#x0D; MATERIALS AND METHODS. Generalization and analysis of scientific publications on the research topic.&#x0D; RESULTS. The article summarizes data on the pathogenetic rationale for the appointment of hormone therapy, as well as the effectiveness of antiestrogens and aromatase inhibitors in the treatment of primary ovarian cancer and recurrences of the disease.&#x0D; CONCLUSIONS. To date, indications for the appointment and criteria for the use of hormone therapy in the complex treatment of ovarian cancer are not developed. The question of the reliability of the factors of the disease prognosis, taking into account the hormonal receptor status of ovarian cancer, remains open.

Association Between the Route of Administration and Formulation of Estrogen Therapy and Hypertension Risk in Postmenopausal Women: A Prospective Population-Based Study.

Hypertension is the leading global cause of cardiovascular disease and premature mortality in women. The effects of postmenopausal hormone therapy (HT) on blood pressure are uncertain but may be related to route of estrogen administration and formulation of estrogen. We sought to determine the association between route of administration and formulation of estrogen HT and hypertension risk in postmenopausal women. Population-based cohort study with women aged ≥45 years who filled ≥2 consecutive prescriptions for estrogen-only HT, identified from linked provincial health administrative data from Alberta, Canada, between 2008 and 2019. The primary outcome, incident hypertension, was identified using standardized International Classification of Diseases, Ninth and Tenth Revision. Cox proportional hazard models were used to calculate hazard ratios (HRs) for hypertension in women using oral HT compared with nonoral HT (transdermal, vaginal, or intramuscular). In total, 112 240 women used an estrogen-only form of HT. Oral estrogen was associated with a higher risk of hypertension compared with both transdermal (HR, 1.14 [95% CI, 1.08-1.20]) and vaginal (HR, 1.19 [95% CI, 1.13-1.25]) estrogens. Conjugated equine estrogen was associated with an increased risk of hypertension compared with estradiol (HR, 1.08 [95% CI, 1.04-1.14]) but not estrone (HR, 1.00 [95% CI, 0.93-1.10]). Duration of estrogen exposure and cumulative dose of estrogen was positively associated with risk of hypertension. Oral estrogen-only HT use was associated with an increased risk of hypertension in women. In women using estrogen-only HT, nonoral estradiol at the lowest dose and for the shortest time-period is associated with the lowest risk of hypertension.