Starting Hormone Therapy Research Articles

Immunoglobulin A-dominant membranoproliferative glomerulonephritis-like pattern of injury as a possible paraneoplastic nephropathy in a breast cancer patient.

A middle-aged woman was found to have proteinuria during a health check-up. About sixteen months later, she was diagnosed with stage IIA invasive ductal carcinoma of the right breast. Her proteinuria progressed to nephrotic syndrome with significant hematuria. Hormone therapy was initiated for her estrogen and progesterone receptor-positive breast cancer. A kidney biopsy performed 47days after starting the therapy revealed an IgA-dominant membranoproliferative glomerulonephritis-like pattern of injury. Electron microscopy showed subendothelial-dominant electron-dense deposits (EDD), with small amounts of mesangial EDD and a single occurrence of subepithelial hump-like EDD, along with occasional mesangial interpositions. Similar pathology can be caused by IgA vasculitis with nephritis, IgA-dominant infection-associated glomerulonephritis, and liver disease-associated glomerulopathy, but all of these were ruled out. The deposited IgA was found to be galactose-deficient IgA1. Thus, IgA nephropathy with glomerular capillary IgA deposition was considered. She underwent a right partial mastectomy and sentinel lymph node biopsy in the right axilla 75days after starting hormone therapy, followed by adjuvant radiation. Proteinuria and hematuria tended to decrease after the treatment, and this trend continued even after corticosteroid therapy for glomerulonephritis, which was administered 156days after starting hormone therapy. Approximately 15months after starting hormone therapy, her proteinuria had reduced to around 1.0g/g of creatinine, and her hematuria was negative. IgA nephropathy with glomerular capillary IgA deposition is known to be resistant to corticosteroid therapy. The favorable clinical course of the rare glomerulopathy following breast cancer treatment suggested a diagnosis of paraneoplastic glomerulopathy secondary to breast cancer in our patient.

The Importance of Fertility Preservation in the Transgender Population

ObjectiveTo call to attention the often-overlooked aspect of pediatric transgender care: the importance of fertility preservation prior to instituting gender-affirming therapy. The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues has caused disparities to widen. Gender affirming procedures and hormone therapy affect the long-term reproductive potential of transgender individuals. While cost concerns and insurance coverage regarding oncofertility is a prominent area of discussion, the transgender community is often excluded. MethodsSixteen genetically XY females, followed by their multidisciplinary transgender care teams, were interested in starting hormone therapy due to impending onset and/or progression of puberty. Their physicians were aware of fertility struggles after undergoing hormone therapy and therefore referred to urology. Sperm cryopreservation via open gonadal biopsy, testicular tissue cryopreservation (TTC), and semen sample (when age/maturity-appropriate) were discussed. Though requiring surgery, biopsy/TTC relieves patients of the psychological impact of semen sample production. ResultsUnder IRB approval, 15 patients (median age 12 years, range 10-16 years) underwent TTC (Figure 1). One patient (aged years) opted for semen sample. All patients had success with spermatogonial stem cells cryopreserved for future patient use. ConclusionsWith more individuals beginning medical and surgical therapy at a younger age, fertility preservation discussions are essential but often overlooked, depriving these individuals the joy of becoming a biological parent. TTC can be safely done in pediatric populations, though research is necessary to expand beyond current experimental stage of tissue-development.

Dissociative Experiences Among Transgender Women: A Phenomenological Study

ABSTRACT There is little published research on dissociative experiences among transgender people, and none from an in-depth qualitative perspective. In-depth, open-ended interviews (N = 7, 6 trans women, 1 trans man) were conducted to explore how dissociation is experienced (particularly among trans women) and its possible relation to negative emotions. There were several similarities across the dissociative experiences described by participants: six felt themselves disconnected from their body as a whole (in contrast to feeling disconnected to a specific body part), and from the world around them and/or themselves. Four acted out different personalities, and five felt emotionally numb when they were dissociating. Six participants described that their dissociation lessened after they started hormone therapy. Respondents tended to distinguish between dysphoric and dissociative experiences: dysphoric phenomena were more clearly distressful while dissociative ones were more emotionally numb.

(286) Impact of Hormonal Treatment in Patients with Gender Dysphoria in the First Six Months of Treatment

Abstract Introduction Gender dysphoria (GD) is a mismatch of how we feel our identity, male or female, with the biological sex. This incongruity can lead to discomfort and suffering. Prejudice and discrimination may result in additional stress, with impact on quality of life (QV). Hormonal therapy (HT) is an important part of the treatment of patients with GD and can have an impact on sexual life and QV. Objective To assess the impact of HT on sexual desire and quality of life in patients with GD throughout the first 3 to 6 months of treatment. Methods Longitudinal study of quality of life (QL) and sexual desire (SD), before and 3 to 6 months after starting HT, using the WHO WHOQOL-BREF questionnaire, which assesses the physical, psychological, social and environmental domains, of DS (dyadic and solitary) through the Sexual Desire Inventory- 2 (SDI-2) questionnaire and obtaining sociodemographic, clinical and laboratory data on patients who came to our consultation with a diagnosis of GD. Results 52 patients, with a mean age of 25.11 (18–56) years, completed the WHOQOL-BREF and SDI-2 questionnaires. 30 FtM (57.7%) and 22 MtF (42.3%). Almost half 49% (n= 26) had a comorbid psychiatric disorder. In FtM the average total testosterone (TT) increased from 0.320 ng/mL to 7.190 (+/- 2.340) ng/mL and in MtF the average TT increased from 6.86 ng/mL to 0.59 (+/- 41) ng/mL 3 to 6 months after starting HT, without serious side effects. FtM showed a significant increase in DS (p < 0.01), both dyadic and solitary, while MtF showed a non-significant decrease in SD after the start of HT. There was a non-significant improvement in the physical, social relationships and environment domains and a significant improvement in the psychological domain (p < 0.01). In the physical domain, FtM patients showed a significant improvement compared to MtF patients. 20% of patients reduced or stopped psychiatric medication. Despite the negative impact of HT on SD in MtF, there was an improvement in QoL and a reduction in the need for psychiatric medication. In FtM there was a significant improvement in the psychological and physical domain. Conclusions HT is safe, improves QoL and reduces the need for psychiatric medication in patients with GD. This improvement was significant in the psychological domain. Disclosure No.

Using hormonotherapy in breast cancer and its relationship with metabolic syndrome

Aims: This study aims to investigate whether the use of hormonotherapy pharmaceuticals causes metabolic syndrome-like symptoms in patients diagnosed with breast cancer and to compare the long-term effects of the drugs. Methods: This retrospective file analysis was conducted on breast cancer patients who presented to the Radiation Oncology clinic between January 2019 and April 2022. Files of 75 patients diagnosed with breast cancer, postmenopausal, and without any previous chronic diseases such as diabetes or hypertension were included in the study. Patients who were started on medications with different active ingredients (tamoxifen citrate, letrozole or anastrazole) in the adjuvant period were examined in 3 groups. Waist circumference thickness, body weight, blood pressure, and blood biochemical tests (blood glucose, lipid levels) were measured before and 6 months after the start of the drugs, and the values were compared retrospectively. Results: Of the 75 patients included in the study, the average age of patients using tamoxifen was 59.6; The average age of patients using letrozole was 59.12 years and the average age of patients using anastrozole was 63.56 years. There was an increase in fasting blood sugar (p:0.014) and waist circumference (p:0.009) in the tamoxifen group. There was an increase in fasting blood sugar, weight, waist circumference, blood pressure and lipid levels in the letrozole and anastrazole arms (p<0.0001 for all). Furthermore, comorbidities such as diabetes mellitus and hypertension that developed after using drugs were ascertained. Conclusion: We think that there is a significant association between hormonotherapy medicines used in breast cancer and metabolic syndrome. While we found increases in blood lipids, FBG, body weight, and waist circumference in most of the patients, we observed that these increases were significantly higher in the groups using aromatase inhibitors. These patients should be examined in detail before starting hormone therapy. Diet, active lifestyle, and sports should be recommended.

Priorities for data collection through a prospective cohort study on gender-affirming hormone therapy in Aotearoa New Zealand: community and clinical perspectives.

Introduction Gender affirming hormone therapy (GAHT) is an important aspect of health care for many transgender and non-binary (TNB) people, but little is known about the long-term outcomes for TNB people in Aotearoa New Zealand (NZ). Pathways to access GAHT are shifting from secondary care towards primary care, so this is an opportune time to commence local research on long-term health and wellbeing outcomes for people initiating GAHT. Aim This paper aims to report on the key findings from four meetings held to inform the design of a prospective cohort study to follow the journey of people initiating GAHT in primary and secondary care settings in NZ. Methods We worked with a community advisory group of six TNB young people and sought input from 14 health care providers involved in the care of TNB people initiating GAHT (GPs, secondary care doctors, and mental health providers). Semi-structured interview schedules were used to guide discussions. Template analysis was used to initially code data based on themes identified from the interview schedule and new themes from discussions were added. Results Participants shared ideas about recruitment and data collection priorities for baseline and follow-up surveys. These included understanding the journey to starting hormone therapy (information-seeking, decision-making), access to services for GAHT initiation, appropriateness of information provision, receipt of the first prescription, goals for and experience of GAHT, and the unique needs of non-binary people. Discussion Input from a TNB advisory group and health care professionals has informed the development of a survey that will be used to understand the experience of, and outcomes for, people starting GAHT in NZ. Findings from this planned prospective cohort study have the potential to improve access to GAHT for TNB people who wish to pursue this option.

Patterns of psychotropic medication prescribing and potential drug-hormone interactions among transgender and gender-diverse adults within 2 years of hormone therapy

BackgroundTransgender and gender-diverse (TGD) people have a high prevalence of psychotropic medication use, yet knowledge about the patient-level psychotropic medication burden is limited. TGD patients may take hormone therapy to meet their gender expression goals. Potential drug-hormone interactions exist between psychotropic medications and hormone therapy, requiring increased knowledge about psychotropic medication use for TGD adults undergoing hormone therapy. ObjectivesThe objective of this study was to examine the extent of psychotropic medication polypharmacy in a cohort of TGD adults within 2 years of starting hormone therapy. We also characterized potential drug-hormone interactions and the association with psychotropic polypharmacy. MethodsRetrospective cross-sectional analysis of patients with ≥1 transgender health-related visit (2007−2017) in the University of Washington Medical System (Seattle, WA). Eligible patients had ≥1 psychotropic medication including antidepressants, antipsychotics, mood stabilizers, and sedative-hypnotics ordered within 2 years of starting hormone therapy (testosterone or estradiol with or without spironolactone, progesterone, finasteride, or dutasteride). We defined psychotropic polypharmacy as ≥2 psychotropic medication orders with overlapping treatment durations for at least 90 days and characterized potential drug-hormone interactions (Lexicomp, Hudson, OH). We descriptively summarized patients with and without polypharmacy (frequencies and percentages) and compared drug-hormone interactions using chi-square or Fishers exact tests (P < 0.05 considered significant). ResultsA total of 184 patients had ≥1 psychotropic medication order within 2 years of hormone therapy; 68 patients (37.0%) had psychotropic polypharmacy. The most frequent type of psychotropic polypharmacy was antidepressant+sedative-hypnotic (18 of 68, 26.5%). More patients had a potential drug-hormone interaction among those with psychotropic polypharmacy (23 of 68, 33.8%) versus those without (8 of 116, 6.9%, P < 0.001). ConclusionAmong TGD patients on psychotropic medications within 2 years of hormone therapy, one-third had psychotropic polypharmacy. Most polypharmacy types appeared to align with mental health treatment guidelines. The number of patients with a potential drug-hormone interaction was significantly higher among those with polypharmacy. Prospective studies are needed to characterize drug-hormone interactions.

SAT416 The Incidence Of Autoimmune Disease In Transgender People After Initiation Of Gender-Affirming Hormone Therapy

Abstract Disclosure: C. Wiepjes: Advisory Board Member; Self; Novartis Pharmaceuticals. M. Den Heijer: None. Background Autoimmune diseases are more common in women than in men, possibly caused by differences in sex hormones. Generally, estrogen has an immunoenhancing effect, while testosterone has an immunosuppressive effect. However, it is not known whether gender-affirming hormone therapy in transgender people affects the risk of developing autoimmune diseases. Therefore, we aimed to compare the incidence of autoimmune diseases in trans women and trans men during hormone therapy with rates from the general population. Methods All people who visited the gender identity clinic in Amsterdam, the Netherlands, between 1972 and 2018 were included (n=8831). The medical records were screened for the occurrence of autoimmune diseases. In addition, the cohort was linked to a nationwide health data registry with medical diagnoses, as not all people received their check-ups at our clinic and in order to compare with a control population. These additional diagnoses were available from 2012-2017 and based on Diagnosis-Treatment-Combination codes. People were excluded for analyses if they did not use gender-affirming hormones (n=3022), did not have a follow-up visit (n=345), could not be linked with the nationwide health data registry (n=630), used alternating testosterone and estradiol (n=38), or had an autoimmune disease before start of hormone therapy (n=112). Standardized incidence ratios (SIR) were computed for trans women and trans men compared with the general population. Results In total, 4684 people were included, of which 2830 trans women and 1854 trans men. Median age at start of hormone therapy was 29 years (IQR 22 to 40) in trans women and 22 years (IQR 18 to 29) in trans men. Median follow-up time was 10 years (IQR 3 to 22, max 59) in trans women (total 38326 person years) and 4 years (IQR 1 to 13, max 48) in trans men (total 16548 person years). In total, 55 trans women and 48 trans men developed an autoimmune disease, after a median duration of hormone therapy of 7 years (IQR 2 to 17) in trans women and 5 years (IQR 1 to 12) in trans men. In the analyses with first autoimmune disease between 2012 and 2017, 25 trans women had an event, while 31 cases (SIR 0.81, 95%CI 0.52 to 1.16) were expected compared to cis men and 47 cases (SIR 0.54, 95%CI 0.35 to 0.77) compared to cis women. In trans men, 27 people had an event, while 15 cases were expected compared to cis men (SIR 1.81, 95%CI 1.19 to 2.55) and 23 cases were expected compared to cis women (SIR 1.16, 95%CI 0.77 to 1.64). Conclusion The risk of developing autoimmune diseases in trans women using gender-affirming hormones was similar to the risk in cis men, whereas trans men had a similar risk as cis women. This implies that gender-affirming hormone therapy does not influence the risk of developing autoimmune diseases. For further research it is interesting to see whether the severity of autoimmune diseases changes in trans people starting gender-affirming hormones. Presentation: Saturday, June 17, 2023

Study of prostate-specific antigen levels during salvage radiotherapy after prostate cancer surgery

BackgroundAdministration of adjuvant or salvage radiotherapy (RT) after prostate cancer (PCa) surgery is supported by clinical evidence and is a widely adopted strategy. On occasion, we detect changes in prostate-specific antigen (PSA) levels, such as a transient elevation or decline, during RT. Thus, we retrospectively investigated the frequency of changes in PSA levels, their associations with histopathological parameters, PSA doubling time (PSADT), and biochemical recurrence (BR) of PCa.MethodsThis study included 23 consecutive patients who underwent surgery for PCa between 2012 and 2019, received salvage RT without hormone therapy, and exhibited changes in PSA levels during RT. The prostatic bed was irradiated with a total dose of 64 to 66 Gy. BR was defined as consecutive PSA levels exceeding 0.2 ng/mL or having to start hormone therapy because of PSA elevation after salvage RT.ResultsDuring salvage RT after PCa surgery, PSA levels transiently increased in 11 patients (47.8%) and decreased in 12 (52.2%). When factors associated with BR were examined in patients with transient PSA elevation, seminal vesicle invasion and preoperative PSA values were identified as being statistically significant. When factors for BR were examined in patients with a decline in PSA levels, the Gleason score and PSADT were identified as being significant. Among the cases of a decline in PSA levels during salvage RT, those who received a radiation dose of less than 36 Gy did not experience BR. Similarly, patients who exhibited changes in PSA levels during salvage RT and did not have perineural invasion did not experience BR.ConclusionThis is the first study to examine the histopathological factors possibly affecting BR in patients undergoing salvage RT after PCa surgery. The results indicate that in patients with transient PSA elevation, seminal vesicle invasion is a significant risk factor. On the other hand, in patients with a decline in PSA levels during irradiation, the Gleason score and perineural invasion were found to be potential risk factors for BR. These findings suggest that a thorough examination of postoperative histopathological results may be necessary for the optimal management of patients with PCa.

(274) Sexual Behaviors and Social Barriers to Access Public Health of Brazilian Transgender Men

Abstract Introduction There is a need of information about transgender individuals and their health needs. This work has as object of study sexual behaviors and social barriers to access health of transgender men. There is a need for information about transgender men and their health needs. Globally, transgender people face discrimination and social exclusion. Available data indicate numerous healthcare inequities between trans and cisgender (non-trans) people. Objective The aim of this study was to evaluate transgender men at a public university hospital linked to brazilian´s public healthcare, analyzing sexual practices and barriers to access affirmative care. Methods The medical records of seventeen patients (range 18-42 of age) followed between 2016 and 2018, were used to collect data retrospectively and descriptively with quantitative and qualitative approach. Through a structured interview, there was a focus on data concerning difficulties to reach healthcare and medical inequities. Results It was noticed that transgender men face social barriers to health access, such as insistent non-respect of the use of the social name, the lack of knowledge of health demands by health professionals and the barriers imposed by family and/or spouse. The sexual practices performed by these men, who proved to be widely diverse and changing, are mostly penetrative (70,58%), and such practices may be passive and / or active. It was also observed variable sexual orientation among the patients, although most of them (88,23%) maintain a relationship with a cisgender woman. Gynecological follow-up was also the subject of discussion in this study, and despite the fact that 23,52% of patients had gynecological complaints, 29,41% had never done a gynecological consultation, being the resistance to do gynecological exams very commun. Only 28,57% of the patients had not yet started hormone therapy, and they declared that they would like to start this process. The majority of transgender men have also the need of body change. Conclusions Therefore, it is necessary to develop strategies in public and universal health that are effective to provide transgender men with their need to body change or hormone therapy, as well as to guide them to the gynecological examination. Additionally, health care providers need to guarantee proper and free of prejudice assistance. Disclosure No

(045) The Importance of Fertility Preservation in the Transgender Population

Abstract Introduction The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues has caused disparities to widen. Objective The purpose of this case study is to call to attention the often-overlooked aspect of pediatric transgender care: the importance of fertility preservation prior to instituting gender-affirming therapy. Methods Twenty-one genetically XY females, followed by their multidisciplinary transgender care teams, were interested in starting hormone therapy due to impending onset and/or progression of puberty. Fortunately for these patients, their physicians were aware of fertility struggles after undergoing hormone therapy. Results Sperm cryopreservation via open gonadal biopsy, testicular tissue cryopreservation (TTC), and semen sample (when age/maturity-appropriate) were discussed. Though requiring surgery, biopsy/TTC relieves patients of the psychological impact of semen sample production. With IRB approval, 20 patients (median age 12 years, range 10-16 years) underwent TTC (Figure 1). One patient (age 16 years) opted for semen sample. All patients had success with spermatogonial stem cells cryopreserved for future patient use. Conclusions Gender affirming procedures and hormone therapy affect the long-term reproductive potential of transgender individuals. While cost concerns and insurance coverage regarding oncofertility is a prominent area of discussion, the transgender community is often excluded. With more individuals beginning medical and surgical therapy at a younger age, fertility preservation discussions are essential but often overlooked, depriving these individuals the joy of becoming a biological parent. As health care providers, addressing psychological, emotional, physical, and spiritual needs of patients is crucial, and fertility is a key aspect of this care. TTC can be safely done in pediatric populations, though research is necessary to expand beyond current experimental stage of tissue-development. Disclosure No

Changes in laboratory results in transgender individuals on hormone therapy - a retrospective study and practical approach.

Interpreting laboratory results for transgender individuals who started hormone therapy requires careful consideration, specifically for analytes that have sex-specific reference intervals. In literature, conflicting data exist on the effect of hormone therapy on laboratory parameters. By studying a large cohort, we aim to define what reference category (male or female) is most appropriate to use for the transgender population over the course of gender-affirming therapy. A total of 2201 people (1178 transgender women and 1023 transgender men) were included in this study. We analyzed hemoglobin (Hb), hematocrit (Ht), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), creatinine, and prolactin, at three different time points: pretreatment, during hormone therapy, and after gonadectomy. For transgender women, Hb and Ht levels decrease after initiation of hormone therapy. The concentration of liver enzymes ALT, AST, and ALP decrease whereas the levels of GGT do not change statistically significantly. Creatinine levels decrease whereas prolactin levels rise in transgender women during gender-affirming therapy. For transgender men Hb and Ht values increase after starting hormone therapy. Liver enzymes and creatinine levels increase statistically significant as well upon hormone therapy while prolactin concentrations decrease. Overall, reference intervals in transgender people after 1 year on hormone therapy resembled those of their affirmed gender. Generating transgender-specific reference intervals is not essential to correctly interpret laboratory results. As a practical approach, we recommend to use the reference intervals of the affirmed gender from 1 year onwards after starting hormone therapy.

MP43-09 THE IMPORTANCE OF FERTILITY PRESERVATION IN THE TRANSGENDER POPULATION

You have accessJournal of UrologyCME1 Apr 2023MP43-09 THE IMPORTANCE OF FERTILITY PRESERVATION IN THE TRANSGENDER POPULATION Niki Parikh, MN Rochester, Glenn Cannon, Asma Chattha, Patricio Gargollo, Kyle Orwig, Brooke McClendon, David Walker, and Candace Granberg Niki ParikhNiki Parikh More articles by this author , MN RochesterMN Rochester More articles by this author , Glenn CannonGlenn Cannon More articles by this author , Asma ChatthaAsma Chattha More articles by this author , Patricio GargolloPatricio Gargollo More articles by this author , Kyle OrwigKyle Orwig More articles by this author , Brooke McClendonBrooke McClendon More articles by this author , David WalkerDavid Walker More articles by this author , and Candace GranbergCandace Granberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues has caused disparities to widen. The purpose of this case study is to call to attention the often-overlooked aspect of pediatric transgender care: the importance of fertility preservation prior to instituting gender-affirming therapy. METHODS: Twenty-one genetically XY females, followed by their multidisciplinary transgender care teams, were interested in starting hormone therapy due to impending onset and/or progression of puberty. Fortunately for these patients, their physicians were aware of fertility struggles after undergoing hormone therapy. RESULTS: Sperm cryopreservation via open gonadal biopsy, testicular tissue cryopreservation (TTC), and semen sample (when age/maturity-appropriate) were discussed. Though requiring surgery, biopsy/TTC relieves patients of the psychological impact of semen sample production. Under IRB approval, 20 patients (median age 12 years, range 10-16 years) underwent TTC (Figure 1). One patient (age 16 years) opted for semen sample. All patients had success with spermatogonial stem cells cryopreserved for future patient use. CONCLUSIONS: Gender affirming procedures and hormone therapy affect the long-term reproductive potential of transgender individuals. While cost concerns and insurance coverage regarding oncofertility is a prominent area of discussion, the transgender community is often excluded. With more individuals beginning medical and surgical therapy at a younger age, fertility preservation discussions are essential but often overlooked, depriving these individuals the joy of becoming a biological parent. As health care providers, addressing psychological, emotional, physical, and spiritual needs of patients is crucial, and fertility is a key aspect of this care. TTC can be safely done in pediatric populations, though research is necessary to expand beyond current experimental stage of tissue-development. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e604 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niki Parikh More articles by this author MN Rochester More articles by this author Glenn Cannon More articles by this author Asma Chattha More articles by this author Patricio Gargollo More articles by this author Kyle Orwig More articles by this author Brooke McClendon More articles by this author David Walker More articles by this author Candace Granberg More articles by this author Expand All Advertisement PDF downloadLoading ...

Interindividual differences contribute to variation in microbiota composition more than hormonal status: A prospective study.

Ovarian hormone deficiency is one of the main risk factors for osteoporosis and bone fractures in women, and these risks can be mitigated by menopausal hormone therapy. Recent evidence suggests that gut microbiota may link changes in estrogen levels and bone metabolism. This study was conducted to investigate the potential relationship between hormonal and bone changes induced by oophorectomy and subsequent hormonal therapy and shifts in gut microbiota composition. We collected 159 stool and blood samples in several intervals from 58 women, who underwent bilateral oophorectomy. Changes in fecal microbiota were assessed in paired samples collected from each woman before and after oophorectomy or the start of hormone therapy. Bacterial composition was determined by sequencing the 16S rRNA gene on Illumina MiSeq. Blood levels of estradiol, FSH, biomarkers of bone metabolism, and indices of low-grade inflammation were measured using laboratory analytical systems and commercial ELISA. Areal bone mineral density (BMD) of the lumbar spine, proximal femur, and femur neck was measured using dual-energy X-ray absorptiometry. We found no significant changes in gut microbiota composition 6 months after oophorectomy, despite major changes in hormone levels, BMD, and bone metabolism. A small decrease in bacterial diversity was apparent 18 months after surgery in taxonomy-aware metrics. Hormonal therapy after oophorectomy prevented bone loss but only marginally affected gut microbiota. There were no significant differences in β-diversity related to hormonal status, although several microbes (e.g., Lactococcus lactis) followed estrogen levels. Body mass index (BMI) was the most significantly associated with microbiota variance. Microbiota was not a suitable predictive factor for the state of bone metabolism. We conclude that neither the loss of estrogens due to oophorectomy nor their gain due to subsequent hormonal therapy is associated with a specific gut microbiota signature. Sources of variability in microbiota composition are more related to interindividual differences than hormonal status.

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.

Successful medical management of an acute life‐threatening haemorrhagic crisis related to acquired colonic vascular ectasia in a dog

AbstractA 7‐year‐old, neutered, male miniature pinscher was presented with a 36‐hour history of acute life‐threatening haematochezia and severe anaemia (haematocrit 4.9%). A diagnosis of acquired colonic vascular ectasia was ultimately made from the characteristic gross morphologic vascular abnormalities visualised during colonoscopy. A combination ethinyl estradiol and norethindrone acetate tablet was prescribed. On recheck 6 weeks after starting hormone therapy, the patient had not had haematochezia for the previous 4 weeks (haematocrit 34%). On the recheck visit 12 months after starting hormone therapy, haematocrit was within reference range (50%) and the patient had not had diarrhoea or haematochezia for the preceding 9 months. This is the first case report describing a successful medical management of an acute haemorrhagic crisis related to acquired colonic vascular ectasia without endoscopic‐assisted argon therapy or colectomy.

The study of correlation of estrogen receptor, progesterone receptor, and HER2 receptor status in breast cancer and its incidence in a tertiary center hospital in south India

Background: Breast cancer is the most common cancer in female representing approximately 25% of all cancer. It is also ranked number one cancer among Indian females with ageadjusted incidence rate of 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Hormone receptors are the receptor protein found in normal breast cells. Aims and Objectives: The aims of this study were to assess the histologic type, estrogen receptor (ER), progesterone receptor (PR), and HER2/neu of all breast carcinoma patients coming to the inpatient department of general surgery of a tertiary care hospital. This study was conducted to assess the histologic type, ER, PR, and HER2/neu of all breast carcinoma patients coming to the outpatient department of general surgery of a tertiary care hospital. Materials and Methods: The present study is a prospective observational study conducted in the department of general surgery at KR Hospital for 1 year from December 2020 to November 2021. All patients who underwent modified radical mastectomy for breast carcinoma or core biopsy to start chemotherapy and hormone therapy before surgery were included in the study. They were subjected to histopathological examination and immunochemistry. Results: The most common age group, in which breast carcinoma was diagnosed, was 51–55 years. The most common type of breast carcinoma is invasive ductal carcinoma seen in 66% of the patients. Among the 100 patients IHC, ER positive was seen in 54% of the patients, PR positive was seen in 39% of the patients, and HER2neu-positive was seen in 31% of the patients. Most common was ER/PR+HER2neu – in 28% of the patients. Triple-negative hormonal status was seen in 23% of the patients. Conclusion: This single institutional study of 100 cases of breast cancer patients from South India suggest that mean age of breast cancer patient was between 51 and 55 years, with invasive ductal carcinoma being the most common histological type with ER positivity of 54% and PR positivity of 39% and triple-negative cancers of 23%, not grossly different from rest of the country but significantly lower than Western studies.

Induction of ovarian steroidogenesis as an additional potential risk factor for progression in premenopausal patients with hormone-receptor-positive breast cancer receiving tamoxifen as adjuvant therapy

Introduction. Patients with hormone-receptor-positive (HR+) breast cancer (BC) over 40 years old who take tamoxifen are not subject to mandatory castration. However this cohort of patients is not homogeneous.Aim. The present study is aimed at studying the features of ovarian steroidogenesis in perimenopausal breast cancer patients receiving adjuvant hormone therapy (HT) with tamoxifen.Materialy and methods. The study included 82 patients aged 42 to 53 years with GH+BC who received HT with tamoxifen 20 mg daily. Within 9 months from the start of HT in patients, the levels of estradiol and follicle-stimulating hormone in the peripheral blood were studied every 3 months.Results. In 66.7% of patients who received chemotherapy (CT), the development of amenorrhea was noted. Half of the patients in the HT-only group demonstrated amenorrhea. Oligomenorrhea was observed in 20.8% and 16.7% in each group, respectively. The incidence of amenorrhea in women treated with chemotherapy was higher (OR 2.02; 95% CI: 0.73-5.67), but the differences were not statistically significant (p = 0.1766). In the general cohort, in 15.7-16.8% of patients, the level of estradiol exceeded 251 pg / ml - the upper limit of the norm of the follicular phase of the menstrual cycle. Differences between groups in the incidence of estradiol levels &gt; 251 pg/ml were statistically significant (p = 0.0293). 3.4-5.6% of patients in the total cohort (depending on the period of observation) had an estradiol level &gt; 649 pg / ml, which corresponded to the highest ovulatory value.Conclusions. Against the background of HT with tamoxifen in some perimenopausal patients hyperestrogenism is observed which indicates the implementation of the effect of induction of ovarian steroidogenesis and can be considered as an additional potential risk factor for the progression of HR+BC. Amenorrhea after CT is not a reliable marker of ovarian suppression.

Cost-utility analysis of adding abiraterone acetate plus prednisone/prednisolone to long-term hormone therapy in newly diagnosed advanced prostate cancer in England: Lifetime decision model based on STAMPEDE trial data.

Adding abiraterone acetate (AA) plus prednisolone (P) to standard of care (SOC) improves survival in newly diagnosed advanced prostate cancer (PC) patients starting hormone therapy. Our objective was to determine the value for money to the English National Health Service (NHS) of adding AAP to SOC. We used a decision analytic model to evaluate cost-effectiveness of providing AAP in the English NHS. Between 2011-2014, the STAMPEDE trial recruited 1917 men with high-risk localised, locally advanced, recurrent or metastatic PC starting first-line androgen-deprivation therapy (ADT), and they were randomised to receive SOC plus AAP, or SOC alone. Lifetime costs and quality-adjusted life-years (QALYs) were estimated using STAMPEDE trial data supplemented with literature data where necessary, adjusting for baseline patient and disease characteristics. British National Formulary (BNF) prices (£98/day) were applied for AAP. Costs and outcomes were discounted at 3.5%/year. AAP was not cost-effective. The incremental cost-effectiveness ratio (ICER) was £149,748/QALY gained in the non-metastatic (M0) subgroup, with 2.4% probability of being cost-effective at NICE's £30,000/QALY threshold; and the metastatic (M1) subgroup had an ICER of £47,503/QALY gained, with 12.0% probability of being cost-effective. Scenario analysis suggested AAP could be cost-effective in M1 patients if priced below £62/day, or below £28/day in the M0 subgroup. AAP could dominate SOC in the M0 subgroup with price below £11/day. AAP is effective for non-metastatic and metastatic disease but is not cost-effective when using the BNF price. AAP currently only has UK approval for use in a subset of M1 patients. The actual price currently paid by the English NHS for abiraterone acetate is unknown. Broadening AAP's indication and having a daily cost below the thresholds described above is recommended, given AAP improves survival in both subgroups and its cost-saving potential in M0 subgroup.

Abiraterone acetate plus prednisolone for metastatic patients starting hormone therapy: 5-year follow-up results from the STAMPEDE randomised trial (NCT00268476).

Abiraterone acetate plus prednisolone (AAP) previously demonstrated improved survival in STAMPEDE, a multiarm, multistage platform trial in men starting long‐term hormone therapy for prostate cancer. This long‐term analysis in metastatic patients was planned for 3 years after the first results. Standard‐of‐care (SOC) was androgen deprivation therapy. The comparison randomised patients 1:1 to SOC‐alone with or without daily abiraterone acetate 1000 mg + prednisolone 5 mg (SOC + AAP), continued until disease progression. The primary outcome measure was overall survival. Metastatic disease risk group was classified retrospectively using baseline CT and bone scans by central radiological review and pathology reports. Analyses used Cox proportional hazards and flexible parametric models, accounting for baseline stratification factors. One thousand and three patients were contemporaneously randomised (November 2011 to January 2014): median age 67 years; 94% newly‐diagnosed; metastatic disease risk group: 48% high, 44% low, 8% unassessable; median PSA 97 ng/mL. At 6.1 years median follow‐up, 329 SOC‐alone deaths (118 low‐risk, 178 high‐risk) and 244 SOC + AAP deaths (75 low‐risk, 145 high‐risk) were reported. Adjusted HR = 0.60 (95% CI: 0.50‐0.71; P = 0.31 × 10−9) favoured SOC + AAP, with 5‐years survival improved from 41% SOC‐alone to 60% SOC + AAP. This was similar in low‐risk (HR = 0.55; 95% CI: 0.41‐0.76) and high‐risk (HR = 0.54; 95% CI: 0.43‐0.69) patients. Median and current maximum time on SOC + AAP was 2.4 and 8.1 years. Toxicity at 4 years postrandomisation was similar, with 16% patients in each group reporting grade 3 or higher toxicity. A sustained and substantial improvement in overall survival of all metastatic prostate cancer patients was achieved with SOC + abiraterone acetate + prednisolone, irrespective of metastatic disease risk group.