Endocrine Abstracts

Introduction: Cross sex hormonal therapy with testosterone is used in female-to-male transgender people to induce the desired secondary sexual features; this could lead to an increased risk of cardiovascular diseases. Data published on this subject is scarce and contradictory.

Objective: To evaluate effects on weight, inflammatory and prothrombotic parameters, lipid profile, and insulin resistance after 3–4 months of testosterone treatment in transsexual men.

Materials and methods: Prospective study including 25 transsexual men who started treatment with testosterone between 2016 and 2017. Average was 23±9.6 years of age. Those with known dyslipidemia, diabetes or thrombophilia were excluded. All of them started the treatment with 250 mg of i.m. testosterone cypionate every 21 days, except for 5 patients who started with 50 mg a day of transdermal testosterone gel, remaining in amenorrhea. Dietary and increased physical activity measures were promoted in all cases.

Results: There was a mean increase in weight after 3–4 months of treatment (72.4±23.4 vs 74.4±24.6 kg, P=0.026), although it was very individually variable. 56% of the participants gained weight (3.7±3.3 kg), while the rest (44%) remained stable or lost weight (−1.5±1 kg). Testosterone treatment was associated with an increase in LDL levels, from 99.4±32 to 105.4±32 mg/dl (P=0.017) and TG levels, from 69.6±28.5 to 86.0±38.2 mg/dl (P=0.048). HDL levels did also decrease (54.9±14.1 vs 44.8±10.6 mg/dl, P <0.001), as those of Apolipoprotein A (161.5±24.4 vs 141.7±23.7 mg/dl, P=0.005). No differences were observed both in CRPus and fibrinogen levels. Homocysteine levels did increase (8.6±2.5 vs 12.1±7.9 umol/l, P=0.037). Fasting glucose level dropped from 87.6±9.6 to 83.6±10.0 mg/dl (P=0.01), but no differences were found in glycosylated hemoglobin levels nor in the HOMA index. An increase in total hemoglobin (13.2±1.0 vs 14.7±1.4 mg/dl, P<0.001) and hematocrit (40.7±3.0 vs 44.9±4.0%, P<0.001) levels was observed, not reaching pathological values in any case. No differences were observed in the platelet count. No positive correlation was observed between higher testosterone or estradiol levels and the variables studied.

Conclusions: There is a worsening of analytical parameters related to cardiovascular risk. There is a weight gain that could be controlled by promoting dietary and physical activity measures.