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Cardiovascular safety in transgender men using testosterone as part of gender-affirming hormone therapy in a portuguese hospital : a retrospective study
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Introdução: A evidência atual sugere, com consistência variável, que os homens transgénero a realizar Terapia Hormonal de Afirmação de Género (GAHT) poderão ter níveis mais elevados de colesterol LDL, triglicéridos e hematócrito, bem como níveis menores de colesterol HDL, o que pode favorecer um aumento do risco cardiovascular. São, contudo, necessários mais estudos nesta população para confirmar se essas alterações existem e quais as implicações clínicas que apresentam para a saúde cardiovascular destes pacientes.
Objetivo: Avaliar os efeitos, em homens transgénero (FtoM), da terapia hormonal com testosterona ao nível de marcadores clínicos e analíticos de risco cardiovascular e da ocorrência de eventos cardiovasculares major.
Métodos: Foi selecionada uma coorte de pacientes em seguimento no Serviço de Endocrinologia do Hospital de Santa Maria. Realizou-se uma análise retrospetiva e observacional da informação clínica dos mesmos em três períodos temporais: previamente à administração de testosterona, seis meses após exposição e doze meses após exposição. Foram ainda avaliados dois períodos adicionais em indivíduos com maior duração de seguimento. Os resultados de interesse consistiram em alterações nos seguintes parâmetros: Pressão arterial (PA) sistólica, PA diastólica, PA média, peso corporal, índice de massa corporal (IMC), colesterol total, colesterol LDL, colesterol HDL, triglicéridos e hematócrito. Foi ainda investigada a ocorrência de eventos cardiovasculares após a exposição.
Resultados: Foram incluídos 57 indivíduos. A idade mediana foi de 26 (AI 10) anos e a duração mediana de seguimento de 24 (AI 39.5) meses. Observaram-se aumentos estatisticamente significativos do peso corporal aos 6 meses (M) (p<0.001) e aos 12M (p=0.010); do IMC aos 6M (p<0.001); e do hematócrito aos 6M (p<0.001), 12M (p<0.001) e aos 5 anos (p<0.001). Os níveis de colesterol HDL diminuíram significativamente aos 6M (p<0.001), 12M (p<0.001) e aos 5 anos (p=0.018). Todos os parâmetros de pressão arterial, bem como os níveis de colesterol total e triglicéridos não demonstraram alterações significativas. Os níveis de colesterol LDL produziram um resultado inconclusivo aos 6M, sem alterações noutros períodos temporais. Não se registaram quaisquer eventos cardiovasculares pós-exposição nos participantes do estudo.
Conclusões: Do nosso conhecimento, este é o primeiro estudo retrospetivo realizado num hospital português a avaliar estatisticamente os efeitos da terapia hormonal com testosterona num painel de marcadores de risco cardiovascular. Confirmámos, com grande magnitude de efeito, um aumento do hematócrito e um decréscimo do colesterol HDL, alterações previamente reportadas. O aumento do peso corporal e do IMC não permite associações diretas com o risco cardiovascular sem informação adicional relativa à composição corporal. A relevância clínica destes achados requer estudos futuros com amostras de maior dimensão e duração de seguimento, considerando o potencial efeito confundidor dos fatores de risco não hormonais e almejando o desenvolvimento de estratégias interventivas desenhadas especificamente para esta população.
Background: Current data suggests, with variable consistency, that transgender men receiving testosterone as part of Gender-Affirming Hormone Therapy (GAHT) may have higher LDL-cholesterol, triglycerides and hematocrit, as well as lower HDL-cholesterol, which can lead to higher cardiovascular risk. However, further studies in this population are required to confirm whether such changes exist and what clinical implications they present for the cardiovascular health of these patients. Aim: To assess the effects of testosterone therapy in transgender Female to Male (FtoM) patients regarding clinical and biochemical markers of cardiovascular risk, as well as the occurrence of relevant cardiovascular events. Methods: A cohort of patients being followed at the Endocrinology unit of Hospital de Santa Maria were selected. A retrospective observational analysis of patients’ data was conducted at three different moments: before administration and after exposure, at six and twelve months. Two additional periods were also assessed in patients with longer follow-up duration, at five and ten years. Outcomes of interest included changes in the following parameters: systolic blood pressure, diastolic blood pressure, mean arterial pressure, body weight, body mass index (BMI), total cholesterol, LDL-c (cholesterol), HDL-c, triglycerides and hematocrit. Patients’ data was also screened for the occurrence of post-exposure cardiovascular events. Results: 57 FtoM patients were included. The median age was 26 (IR 10) years and the median follow-up duration was 24 (IR 39.5) months. Statistically significant increases were observed for weight at 6 months (M) (p<0.001) and 12M (p=0.010); for BMI at 6M (p<0.001); and for hematocrit at 6M (p<0.001), 12M (p<0.001) and 5 years (Y) (p<0.001). HDL-c decreased significantly at 6M (p<0.001), 12M (p<0.001) and 5Y (p=0.018). Blood pressure parameters, total cholesterol and triglyceride levels showed no significant changes at any moment. LDL-c levels had an inconclusive evolution at 6M and no change at other periods. No cardiovascular events occurred after exposure to GAHT in any of the participants. Conclusions: To our knowledge, this is the first retrospective study conducted in a Portuguese hospital to statistically assess the effects of testosterone-based GAHT on an array of cardiovascular risk markers. We confirmed, with a large magnitude, the previously recognized increase in hematocrit and decrease in HDL-c levels. Weight and BMI increases cannot be directly associated with cardiovascular risk without additional body composition data. The clinical relevance of these findings requires confirmation with further studies with larger samples and longer follow-up periods, taking into account the potential confounding effect of non-hormonal risk factors and the possibility of the development of intervention strategies specifically tailored for this population.
Background: Current data suggests, with variable consistency, that transgender men receiving testosterone as part of Gender-Affirming Hormone Therapy (GAHT) may have higher LDL-cholesterol, triglycerides and hematocrit, as well as lower HDL-cholesterol, which can lead to higher cardiovascular risk. However, further studies in this population are required to confirm whether such changes exist and what clinical implications they present for the cardiovascular health of these patients. Aim: To assess the effects of testosterone therapy in transgender Female to Male (FtoM) patients regarding clinical and biochemical markers of cardiovascular risk, as well as the occurrence of relevant cardiovascular events. Methods: A cohort of patients being followed at the Endocrinology unit of Hospital de Santa Maria were selected. A retrospective observational analysis of patients’ data was conducted at three different moments: before administration and after exposure, at six and twelve months. Two additional periods were also assessed in patients with longer follow-up duration, at five and ten years. Outcomes of interest included changes in the following parameters: systolic blood pressure, diastolic blood pressure, mean arterial pressure, body weight, body mass index (BMI), total cholesterol, LDL-c (cholesterol), HDL-c, triglycerides and hematocrit. Patients’ data was also screened for the occurrence of post-exposure cardiovascular events. Results: 57 FtoM patients were included. The median age was 26 (IR 10) years and the median follow-up duration was 24 (IR 39.5) months. Statistically significant increases were observed for weight at 6 months (M) (p<0.001) and 12M (p=0.010); for BMI at 6M (p<0.001); and for hematocrit at 6M (p<0.001), 12M (p<0.001) and 5 years (Y) (p<0.001). HDL-c decreased significantly at 6M (p<0.001), 12M (p<0.001) and 5Y (p=0.018). Blood pressure parameters, total cholesterol and triglyceride levels showed no significant changes at any moment. LDL-c levels had an inconclusive evolution at 6M and no change at other periods. No cardiovascular events occurred after exposure to GAHT in any of the participants. Conclusions: To our knowledge, this is the first retrospective study conducted in a Portuguese hospital to statistically assess the effects of testosterone-based GAHT on an array of cardiovascular risk markers. We confirmed, with a large magnitude, the previously recognized increase in hematocrit and decrease in HDL-c levels. Weight and BMI increases cannot be directly associated with cardiovascular risk without additional body composition data. The clinical relevance of these findings requires confirmation with further studies with larger samples and longer follow-up periods, taking into account the potential confounding effect of non-hormonal risk factors and the possibility of the development of intervention strategies specifically tailored for this population.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Testosterona Terapia hormonal Transgénero Risco cardiovascular Endocrinologia