Masculinizing Hormone Therapy Research Articles

Masculinizing hormone therapy effect on breast tissue: Changes in estrogen and androgen receptors in transgender female-to-male mastectomies

PurposeAlmost two percent of individuals in the United States identify as gender non-conforming. In the female-to-male (FTM) transgender population, masculinizing hormone therapy with testosterone is commonly prescribed in gender transition. To date, the effects of exogenous androgens on breast tissue and its roles in altering breast cancer risk are poorly understood. This study examines the histopathologic findings in gender affirming mastectomy (GAM) in transgender FTM patients and the effects of exogenous androgens on estrogen receptors (ER) and androgen receptors (AR). MethodsA retrospective review of pathology specimens obtained between 2017 and 2020 was performed comparing androgen exposed breast tissue with breast tissue without androgen exposure. Breast specimens were obtained from patients who underwent FTM GAM with recorded exogenous androgen exposure. Control breast specimens were obtained from reduction mammoplasty (RM) procedures in cisgender women which were aged matched to the GAM cohort, as well as postmenopausal women with benign/prophylactic mastectomy procedures; all controls were without androgen exposure. The histopathologic findings were assessed. Immunohistochemistry for AR and ER was performed and the score interpreted by digital image analysis. ResultsAndrogen-exposed breast tissue revealed dense fibrotic stroma, lobular atrophy, thickened lobular basement membranes, and gynecomastoid changes. Longer duration of androgen exposure resulted in a more pronounced effect. The incidence of atypia or cancer was lower in GAM than RM cohort. ER and AR expression was highest in transgender male breast tissue with intermediate duration of exogenous androgen exposure. ConclusionIncreased androgen exposure is associated with lobular atrophy and gynecomastoid changes in breast parenchyma. Overall, ER and AR are expressed strongly in lobular epithelium in patients with prolonged androgen exposure. Exogenous testosterone does not appear to increase risk for breast cancer. Additional studies are needed to investigate the mechanism responsible for these changes at a cellular level and its role in cancer development.

OR31-06 Gender-Affirming Hormone Therapy Affects Serum Cystatin C-based eGFR In Transgender Individuals

Abstract Disclosure: S.A. van Eeghen: None. C. Wiepjes: None. N. Nokoff: None. P. Bjornstad: None. M. Den Heijer: None. D. van Raalte: None. Background: Previous studies in transgender individuals have shown that masculinizing (testosterone) hormone therapy increases and feminizing (estradiol combined with anti-androgen) hormone therapy decreases serum creatinine. Translating this into estimated glomerular filtration rate (eGFR) according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, eGFR increases in transwomen and decreases in transmen during gender-affirming hormone therapy (GAHT). However, serum creatinine is significantly correlated with lean body mass (LBM), which also changes during GAHT, with transmen gaining and transwomen loosing muscle mass. Thus changes in creatinine-derived eGFR during hormone therapy may not reflect true changes in GFR. Another manner to estimate GFR, which is not affected by body composition, is by measuring plasma cystatin C concentrations. Therefore, we studied the effects of GAHT on serum cystatin C, a sex-independent marker for GFR. Methods: In this prospective, observational sub study of the European Network for the Investigation of Gender Incongruence (ENIGI), serum cystatin C was measured in 266 transwomen and 285 transmen before and at 12 months of GAHT. Transwomen received feminizing hormone therapy, consisting of oral (n= 122) or transdermal administration (n= 144) of estrogen in combination with the oral anti-androgen cyproteroneacetate. Transmen received masculinizing hormone therapy, which consisted of intramuscular (n= 144) or transdermal (n= 141) administration of testosterone. Serum cystatin C-based eGFR was calculated according to the full-age-spectrum equation (FAScysC; mL/min/1.73m2). Linear regression was used to assess the means. Results: In transwomen (baseline characteristics; median age 29 (IQR 23-43) years; median BMI 22.9 (IQR 20.8-26.4) kg/m2; creatinine 78.6 ± 9.9 μmol/L; creatinine-based CKD-EPI eGFR 110 ± 14 mL/min/1.73m2), cystatin C decreased by 0.07 (95% CI, 0.05 to 0.09) mg/L; from 0.94 ± 0.17 mg/L before GAHT to 0.87 ± 0.15 mg/L during GAHT. This corresponds with an increase in FAScysC of 7 (95% CI, 5 to 9) mL/min/1.73m2; from 93 ± 17 to 100 ± 18 mL/min/1.73m2. On the contrary, in transmen (baseline characteristics; median age 22 (IQR 20-28) years; median BMI 24.7 (IQR 21.4-30.1) kg/m2; creatinine 66.8 ± 9.3 μmol/L; creatinine-based CKD-EPI eGFR 110 ± 15 mL/min/1.73m2) cystatin C increased by 0.05 (95% CI, 0.03 to 0.07) mg/L; from 0.89 ± 0.17 mg/L before GAHT to 0.95 ± 0.16 mg/L during 12 months of GAHT. This is consistent with a decrease in FASCysC of 6 (95% CI, 4 to 8) mL/min/1.73m2; from 101 ± 19 to 94 ± 15 mL/min/1.73m2. Conclusions: In this large-sized cohort of transgender individuals, cystatin C-based eGFR increased with feminizing hormone therapy and decreased with masculinizing hormone therapy, indicating true biological effects of sex hormones on kidney physiology, which warrants further investigation. Presentation: Sunday, June 18, 2023

OR31-02 Persistence Of Gender Identity And Hormone Therapy Use In Transgender Adolescents: A Retrospective Cohort Study

Abstract Disclosure: P. Gupta: None. B.C. Patterson: None. S. Gold: None. L. Chu: None. H. Yeung: None. M. Goodman: None. V. Tangpricha: None. Introduction: Adolescents with gender dysphoria often seek feminizing or masculinizing hormone therapy to affirm their gender identity. While receipt of gender-affirming hormone therapy (GAHT) has been associated with improved quality of life and well-being, the incidence of discontinuation of GAHT and the reasons for discontinuation are not known. The purpose of this study was to 1) assess the discontinuation rate of GAHT, and 2) explore the reasons for GAHT discontinuation. Methods: This was a retrospective cohort study approved by Emory University’s and Children’s Healthcare of Atlanta’s Institutional Review Board. Medical charts of transgender adolescents seen at Children’s Healthcare of Atlanta were reviewed. Patients met the inclusion criteria if they were prescribed GAHT (estradiol or testosterone) between 01/01/2016 to 01/01/2019. We defined continuation of GAHT if the participant was still taking estradiol or testosterone as of 01/01/2019. If the participant stopped taking hormonal therapy prior to 01/01/19, they were deemed to have discontinued hormonal therapy and the reason for discontinuation was collected from the chart if documented. If the reason was not documented or if the status of hormone discontinuation was not known, the participant was contacted via telephone to ascertain whether still taking GAHT or not and to ascertain the GAHT discontinuation reason if not taking GAHT as a part of phase II of the study. Results: This study included 82 participants; 36 (43.9%) transgender girls, 45 (54.9%) transgender boys, and 1 (1.2%) non-binary adolescent. The mean age of participants was 16.7 (SD= 1.7) years and the majority were white (N= 71; 86.6 %) and non-Hispanic or Latino (N=76; 92.7%). The majority (N= 59, 72.0 %) of the participants were privately insured. The mean duration of hormonal therapy was 21.5 (SD= 15.4) months spanning over a maximum of 66 months. Only 3 participants had discontinued GAHT therapy: one participant stopped hormonal therapy due to insurance issues, one participant stopped GAHT temporarily to conceive a baby and one stopped testosterone to transition to a non-binary gender. No participant re-transitioned to the gender congruent with the sex assigned at birth. Conclusion: Discontinuation of GAHT in this group of transgender adolescents was infrequent. No participant re-transitioned to the gender congruent with the sex assigned at birth while 3 participants discontinued GAHT due to external factors. Pediatric providers should prescribe GAHT in accordance with the Endocrine Society guidelines if the adolescent needing GAHT meets the diagnosis of gender dysphoria, has parental consent, and is pubertal. Presentation: Sunday, June 18, 2023

41945 Incidence and Factors Associated with Acne in Adolescents on Masculinizing Hormone Therapy: A Single-Site Retrospective Cohort Study

41945 Incidence and Factors Associated with Acne in Adolescents on Masculinizing Hormone Therapy: A Single-Site Retrospective Cohort Study

A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people

This systematic review assessed the state and quality of evidence for effects of gender-affirming hormone therapy on psychosocial functioning. Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified. Gender-affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress. Evidence for quality of life was inconsistent, with some trends suggesting improvements. There was some evidence of affective changes differing for those on masculinizing versus feminizing hormone therapy. Results for self-mastery effects were ambiguous, with some studies suggesting greater anger expression, particularly among those on masculinizing hormone therapy, but no increase in anger intensity. There were some trends toward positive change in interpersonal functioning. Overall, risk of bias was highly variable between studies. Small samples and lack of adjustment for key confounders limited causal inferences. More high-quality evidence for psychosocial effects of gender-affirming hormone therapy is vital for ensuring health equity for transgender people.

Masculinizing Hormone Therapy: What Happens to Estradiol and To Total, Free and Biovailable Testosterone?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Pharmacokinetic comparison of three delivery systems for subcutaneous testosterone administration in female mice

Transmasculine individuals are often prescribed testosterone (T) for masculinizing hormone therapy. Mouse models mimicking transmasculine T therapy require reliable long-term T administration. The objectives of this study were three-fold, namely, to compare: 1) the release dynamics of three different subcutaneous delivery systems of T enanthate administration (subcutaneous injections, commercially available pellets, and silastic implants) over a 6-week period in postpubertal C57BL/6N mice, 2) to compare the timing for T levels in plasma to return to baseline and cyclicity to resume after cessation of T between injections and pellets, 3) to utilize silastic implants to achieve sustainable increase in T levels utilizing T enanthate and crystalline T. All three modes of T administration resulted in an increase in T levels in plasma. Pharmacokinetic analyses showed a similar overall exposure to T enanthate over 6 weeks (integrated area) for, subcutaneous injection (0.45 mg two times per week and 0.90 mg one time per week), pellet (5 mg 60-day release), and silastic implant (5 mg 21 week) groups. Crystalline T had lower solubility and a decreased integrated area compared to T enanthate, even when implanted at a higher dosage, indicating different pharmacokinetic profiles based on type of T formulation when utilizing the same silastic delivery method. Surgical removal of pellets and silastic tubing led to a quick drop in T levels and resumption of estrous cyclicity, while cessation of injections required a long washout period for T levels to drop and estrous cycles to resume. Sustained elevation in T levels was achieved for at least 21 weeks with silastic implants. As all three delivery methods are able to elevate T levels in female mice for at least 6 weeks, choice of T administration method should be based on outcomes of interest and study design.

81. The Effect of Masculinizing Hormone Therapy On Wound Healing in Sterilized Mice

Purpose: Wound healing is a topic of great interest in plastic surgery. Prior work has demonstrated sex-dependent differences in wound healing, but mechanisms underpinning these differences are poorly understood. There is general agreement among experts that transgender men on masculinizing hormone therapy heal wounds worse than those who aren’t. The morbidity of this poor wound healing is high and includes problems such as unsightly hypertrophic scars and urethral stenosis. It is known that androgens are associated with an increased local inflammatory response, decreased collagen matrix deposition, and delayed cutaneous wound healing. To further understand this phenomenon, we designed a novel mouse model and studied the effects of trans-sex hormones on wound healing in castrated mice. Methods: CB57BL/6J mice were randomized to 6 groups based on gender, hormone regimen and surgical castration (total n = 75). Ovariectomies, gonadectomies or sham occurred on day 0 and mice were assigned to receive either no-, mono-, or bi-weekly exogenous testosterone for 3 weeks. Bilateral dorsal excisional wounding (6mm punch biopsy) occurred on day 14, and wound were stented open with plastic 6mm rings (secured with suture) to ensure healing via reepithelization as opposed to contraction. Wounds were harvested on day 21 and assessed for planimetry, histology (H&E, trichrome), immunofluorescence, and qPCR (TNFα). Serum testosterone levels were obtained with mass spectrometry. All protocols were approved by Johns Hopkins ACUC. Difference in means was tested with one-way ANOVA with significance set at 0.05. Results: There was a statistically significant difference in mean normalized TNFα concentrations between the six groups (F = 2.50, F critic = 2.35, P = 0.039). Wound sample TNFα concentration was highest in female mice that were on exogenous testosterone. Wound histologic analysis showed poorer wound healing (decreased re-epithelization, larger wound size, increased granulation tissue) in female mice that received exogenous testosterone versus female groups that did not. Conclusion: Preliminary results in our novel murine transgender wound healing model suggest that testosterone increases inflammation and impairs wound healing with significantly more detrimental effects in XX as compared to XY mice, even with identical hormone levels. These effects may be in part mediated by TNFα activity. Ongoing work is focused on characterizing the hormone-mediated effects of TNFα in wound healing in transgender models and developing topical therapeutic interventions.

An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients

An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients

Gender-affirming hormone therapy induces specific DNA methylation changes in blood

BackgroundDNA methylation is an epigenetic mark that is influenced by underlying genetic profile, environment, and ageing. In addition to X-linked DNA methylation, sex-specific methylation patterns are widespread across autosomal chromosomes and can be present from birth or arise over time. In individuals where gender identity and sex assigned at birth are markedly incongruent, as in the case of transgender people, feminization or masculinization may be sought through gender-affirming hormone therapy (GAHT). GAHT is a cornerstone of transgender care, yet no studies to date have investigated its effect on genome-wide methylation. We profiled genome-wide DNA methylation in blood of transgender women (n = 13) and transgender men (n = 13) before and during GAHT (6 months and 12 months into feminizing or masculinizing hormone therapy).ResultsWe identified several thousand differentially methylated CpG sites (DMPs) (Δβ ≥ 0.02, unadjusted p value < 0.05) and several differentially methylated regions (DMRs) in both people undergoing feminizing and masculinizing GAHT, the vast majority of which were progressive changes over time. X chromosome and sex-specific autosomal DNA methylation patterns established in early development are largely refractory to change in association with GAHT, with only 3% affected (Δβ ≥ 0.02, unadjusted p value < 0.05). The small number of sex-specific DMPs that were affected by GAHT were those that become sex-specific during the lifetime, known as sex-and-age DMPs, including DMRs in PRR4 and VMP1 genes. The GAHT-induced changes at these sex-associated probes consistently demonstrated a shift towards the methylation signature of the GAHT-naïve opposite sex, and we observed enrichment of previously reported adolescence-associated methylation changes.ConclusionWe provide evidence for GAHT inducing a unique blood methylation signature in transgender people. This study advances our understanding of the complex interplay between sex hormones, sex chromosomes, and DNA methylation in the context of immunity. We highlight the need to broaden the field of ‘sex-specific’ immunity beyond cisgender males and cisgender females, as transgender people on GAHT exhibit a unique molecular profile.

Treating Acne in Transgender Persons Receiving Testosterone: A Practical Guide.

Transgender persons who undergo masculinizing hormone therapy experience a wide array of dermatologic effects as they initiate and maintain testosterone therapy. Acne is one of the most common adverse effects for many transmasculine patients receiving testosterone. Acne can worsen body image and mental health, with significant impact on quality of life in transgender patients. Specific training and awareness are needed for a clinically and culturally competent encounter while providing care for the transgender patient. This article provides a practical guide for the treatment of testosterone-induced acne in transmasculine patients. Recommendations on creating a welcoming clinical setting, taking a gender-inclusive history, and conducting a patient-centered physical examination relevant to acne care are provided. Assessment of reproductive potential and the appropriate contraceptive methods before prescribing acne treatment with teratogenic potential in transmasculine patients are examined. Interactions between acne treatments with gender-affirming therapies are explored. For patients with severe or treatment-refractory acne, indications, contraindications, and barriers to isotretinoin prescription, such as the US iPLEDGE program, are examined. Multidisciplinary approaches to acne care, involving mental health, reproductive health, gender-affirming hormone therapy and surgeries, are adopted to guide isotretinoin treatment.

Incident Diabetes Risk Is Not Increased in Transgender Individuals Using Hormone Therapy.

ContextIn trans women receiving hormone therapy, body fat and insulin resistance increases, with opposite effects in trans men. These metabolic alterations may affect the risk of developing type 2 diabetes in trans women and trans men.ContextWe aimed to compare the incidence of type 2 diabetes of adult trans women and trans men during hormone therapy with rates from their birth-assigned sex in the general population.MethodsRetrospective data from the Amsterdam Cohort of Gender Dysphoria with transgender individuals on hormone therapy between 1972 and 2018 were linked to a nationwide health data registry. Because no central registry of diabetes is available, the occurrence of diabetes was inferred from the first dispense of a glucose-lowering agent. Standardized incidence ratios (SIR) were computed for trans women and trans men in comparison with the same birth sex from the general population.ResultsCompared with their birth-assigned sex in the general population, no difference in the incidence of type 2 diabetes mellitus was observed in trans women (N = 2585, 90 cases; SIR 0.94; 95% CI, 0.76-1.14) or trans men (N = 1514, 32 cases; SIR 1.40; 95% CI, 0.96-1.92).ConclusionDespite studies reporting an increase in insulin resistance in feminizing hormone therapy and a decrease in insulin resistance in masculinizing hormone therapy, the incidence of diabetes in transgender individuals after initiation of hormone therapy was not different compared with the general population.

The problem of the use of hormonal therapy aimed for sex correction by transgender persons on their own initiative

In recent years, the demand for feminizing and masculinizing hormone therapy has increased significantly among transgender people around the world. There are no such studies in Russia and the amount of medical information on the transgender population is limited. to assess the number of transgender patients who take hormone therapy without a doctor's prescription and to characterize the medicines they use. data from 1117 transgender patients were included in to analysis: 44.01% (n=515) of them were trans women, 55.99% (n=630) were trans men. Patients applied to the "Scientific Center for Personalized Medicine" in order to receive medical care. Half of transgender people (53.6%) are already taking hormonal drugs. More often transgender women (76.7%), less often transgender men (32.3%). In this case, only 8.6% turned to endocrinologists for the therapy prescription. Many patients used unlicensed drugs, use irrational schemes and combinations, often overdose. A significant number of transgender people start using hormone replacement therapy on their own initiative, without the doctor's supervision. The solution to this problem could be incensement of knowledge level in doctors and patients to create a friendly environment and productive interaction between therapists, endocrinologists and transgender people, as well as the organization of consulting centers within public medical institutions.

Histologic Findings in Surgical Pathology Specimens From Individuals Taking Masculinizing Hormone Therapy for the Purpose of Gender Transition.

Transgender men and transmasculine persons experience a discordance between the female sex they were assigned at birth and their gender. They may choose to take hormone therapy and/or undergo surgery to masculinize the body. Understanding the common (and less common) histologic changes present in patients taking masculinizing hormones will empower pathologists to better serve this unique patient population. To summarize histologic findings in surgical pathology specimens from persons taking masculinizing hormones as a part of gender transition. A systematic review of the OVID Medline and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender men from January 1946 to January 2021. Publication in this area has markedly increased in the last 2 decades. However, most of the studies identified were descriptive and case reports describing changes seen in specimens removed as a part of masculinizing surgical procedures. Benign histologic findings include stromal hyalinization and epithelial atrophy in the breast, polycystic ovarian syndrome-like changes in the ovary, and transitional cell metaplasia in the cervix. The most commonly reported neoplastic finding was adenocarcinoma of the breast, with rare cases of ovarian, endometrial, cervical, vaginal, pituitary, pancreatic, and cardiovascular neoplasia also reported. Ongoing research in this area is needed to better characterize the histologic findings in persons taking masculinizing hormones to provide a deeper understanding of the effect of these treatments on different tissues and facilitate better patient management.

22. Assigned Female Infant with Clitoromegaly due to Pre- and Post-Natal Exogenous Testosterone Exposure: A Case Report and Review of the Literature

<h3>Background</h3> Clitoromegaly is an abnormal enlargement of the clitoris that can be congenital or acquired. Both endogenous and exogenous androgen exposure can cause clitoromegaly. We report a case of a 10-month-old assigned female infant with exogenous testosterone exposure resulting in clitoromegaly, with evidence of possible prenatal exposure. There are limited reports of accidental exposure to exogenous androgens in infant females. To our knowledge, only one other case has been reported of possible prenatal exposure causing female infant virilization. <h3>Case</h3> This is a case of a 10-month-old assigned female, born at 39 weeks, referred to our clinic for assessment of clitoromegaly. The enlarged clitoris was first noted by her pediatrician at her six-month exam, although parents state present since birth. Physical exam showed an enlarged clitoris (1.5cm length x 1.5cm width) and an anogenital ratio of 0.5. Laboratory studies revealed significantly elevated total testosterone (826 ng/dL, range for age/sex <10ng/dL) and dihydrotestosterone (851 ng/dL, range <5 ng/dL) levels. Other workup including testing for congenital adrenal hyperplasia, pelvic/adrenal imaging and karyotyping were normal. Patient's father disclosed that he was using topical testosterone gel due to low testosterone levels. At the six-week follow up, the father had discontinued testosterone therapy and infant's labs showed significantly decreased testosterone levels (9.69 ng/dL); given this temporal relationship, the cause of clitoromegaly is likely unintentional exogenous exposure to testosterone. The anogenital ratio of 0.5 is borderline for evidence of prenatal virilization, suggesting possible prenatal androgen exposure via maternal absorption in addition to postnatal exposure. <h3>Comments</h3> This case raises awareness of testosterone absorption in direct physical contacts of those who use topical testosterone gel, leading to unintended hormonal effects. Transdermal testosterone gels are often prescribed to cisgender males with low androgen levels and as a masculinizing hormone therapy in transgender care. Prescribers must educate patients to enact measures to prevent accidental exposure to other household members. The risk of clinically significant absorption may be greater in infants given their high body-surface-area to body weight ratio. Significant early exogenous androgen exposure in assigned female infants has unknown long-term health effects, highlighting the importance of preventing skin contamination with topical testosterone preparations.

Incidence and Factors Associated With Androgenetic Alopecia Among Transgender and Gender-Diverse Patients Treated With Masculinizing Hormone Therapy

This cohort study examines the proportion of transgender and gender-diverse individuals patients receiving masculinizing hormone therapy who developed androgenetic alopecia.

Incidence and Factors Associated With Acne Among Transgender Patients Receiving Masculinizing Hormone Therapy

Acne is a common condition among transgender patients receiving masculinizing hormone therapy (MHT), but the incident risk and predictors of developing acne in this population have not yet been studied on a large scale. To assess risk of acne among a large population of transgender patients receiving MHT and clinical risk factors for acne diagnosis. A retrospective cohort study that included 988 patients who started MHT between January 1, 2014, and December 31, 2017, with at least 1 year of follow-up was performed. Data analysis was conducted from September 1 to 15, 2019. Data were obtained using electronic health records from a community health center serving the sexual and gender minority community. The population included every patient who began receiving MHT during the study period who was aged 18 years or older at the time of MHT initiation and whose assigned sex at birth was female. The main outcome was acne defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes for acne. Overall prevalence and incidence proportions over 2 years after initiation of MHT were calculated. Baseline demographic and clinical characteristics were collected at the time of MHT initiation. A series of univariate analyses for all factors was calculated to test for an association with acne diagnosis, followed by multivariate analyses to test for independent predictors. For 988 patients (median age, 25.8 years; interquartile range, 20.8-28.2 years), there was an overall acne prevalence of 31.1% (n = 307). The 1-year post-MHT acne incidence proportion was 19.0% and the 2-year incidence proportion was 25.1%. A younger age at MHT initiation was associated with a higher likelihood of developing acne, with a median of 22.4 years (interquartile range, 19.7-25.6 years) among patients who developed acne vs 24.7 years (interquartile range, 21.3-29.4 years) among patients who did not (P = .002). Acne is a common condition among transgender patients on MHT, with a prevalence increasing from 6.3% to 31.1% following MHT initiation. Patients aged 18 to 21 years appear to be the most likely to develop acne after MHT initiation.

Effects of testosterone treatment on transgender males: A single-institution study.

Objectives:Data regarding gender-affirming hormone therapy in the Asian population are sparse. We aimed to evaluate the efficacy and safety of testosterone therapy in transgender men.Methods:A retrospective study chart review was conducted in a single university-based transgender clinic. Transgender men aged >18 years who newly started testosterone therapy during January 2015 to October 2019 were recruited. Physical changes, laboratory results, and adverse events, including cancer, thromboembolism, cardiovascular events, and death after masculinizing hormone therapy, were evaluated.Results:A total of 39 transgender men (mean age: 27.8 ± 6.0 years) were included. All individuals were treated with intramuscular testosterone injection with a mean follow-up of 25.2 ± 12.9 months. The most common maintenance regimen was testosterone enanthate 250 mg every 4 weeks. Masculinizing effects developed in all transgender men. There were no changes in body weight, and systolic and diastolic blood pressure. Hematocrit levels were 12% significantly increased from 39.9 ± 3.3% to 48.9 ± 2% (p < 0.001). Ten individuals (25.6%) had hematocrit >50%. Significant changes were found in decreased fasting plasma glucose, increased creatinine, and increased uric acid levels. A non-significantly increased alanine aminotransferase, increased low-density lipoprotein cholesterol, and decreased high-density lipoprotein cholesterol were observed. No thromboembolism, cancer, stroke, or coronary artery disease occurred.Conclusions:Gender-affirming hormone therapy is an effective and safe short-term treatment in Thai transgender men. Apart from the standard recommendation, uric acid, plasma glucose, and creatinine level evaluation before and during masculinizing hormone therapy are rational practices. An intramuscular testosterone enanthate 250 mg every 4 weeks is an alternative masculinizing regimen with decent efficacy and safety profile.

Incident Diabetes Risk is Not Increased in Transgender Individuals Using Hormone Therapy: An Observational Study From the ACOG Study

Background: In trans women receiving hormone therapy, body fat and insulin resistance increases, with opposite effects in trans men. These metabolic alterations may increase or decrease the risk of developing type 2 diabetes in trans women and trans men, respectively. Currently, there is no data on the incidence of type 2 diabetes in transgender individuals. Methods: Retrospective data from the Amsterdam Cohort of Gender Dysphoria with transgender individuals on hormone therapy between 1972 and 2018 were linked to a nationwide health data registry. Because no central registry of diabetes was available, the occurrence of diabetes was deferred from the first dispense of a glucose-lowering agent. Standardized incidence ratios (SIR) were computed for trans women and trans men in comparison with respectively men and women from the general population. Findings: Compared to their birth sex in the general population, no difference in the incidence of type 2 diabetes mellitus was observed in trans women (N = 2585, 90 cases, SIR 0.94 95%CI 0.76–1.14) or trans men (N = 1514, 32 cases, SIR 1.40 95%CI 0.96–1.92). Interpretation: Despite studies reporting an increase in insulin resistance in feminizing hormone therapy and an increase in insulin sensitivity in masculinizing hormone therapy, the incidence of type 2 diabetes in transgender individuals after initiation of hormone therapy was not different compared to the general population. Earlier studies on the effect of hormone therapy on insulin sensitivity in transgender individuals might have revealed specific effects of cyproterone acetate rather than effects of estradiol. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Medical Ethics Committee of the Amsterdam University Medical Centre