Endocrine Abstracts

Background: Individuals with gender incongruence receive gender affirming therapy which is fundamental to sex reassignment. Cross sex hormone treatment both improves and impairs several surrogate markers of cardiovascular risk. In the aging population of transsexual persons, we are called to address clinical endpoints of the long-term gender affirming hormone therapy.

Aim: Aim was to assess changes in the fasting serum lipid profile during gender affirming hormone therapy in Female to Male individuals in a long-term follow-up.

Methods: Retrospective longitudinal study included 10 individuals with Female to Male gender incongruence in the Clinic for Endocrinology, Clinical Center of Serbia, Belgrade, from 1990 to 2017. Diagnosis of transsexualism was confirmed at 26.2+4.3 years of age, based on principles of World Professionals Association for Transgender health. None of the patients has been taking any medication at the initiation of the therapy. Mean body mass index was: 24.1+2.1 kg/m². Median duration of therapy before the assessment was 17.1+1.9 years. Testosterone administered intramusculary was the mainstay of therapy. Socio-demographical, anthropometric and laboratory data were collected. Outcomes of interest included body mass index, total cholesterol, LDL, HDL and triglycerides. Not any patient was lost during a follow up. Data are shown as mean (± standard deviation). Comparisons between means were done by Sign test for paired items. P ≤ 0.05 was considered statistically significant. Statistical analysis was performed with SPSS Statistics 17.0 software (SPSS Inc., Chicago, IL).

Results: In Female to Male individuals, analysis showed no significant difference in total cholesterol, LDL and HDL. TRG levels improved over time (2.0+1.3 to 1.8+0.3 mmol/l), in a statistically significant manner. There was a highly significant difference in body mass index (24.1+2.1 to 26.8+2.5 kg/m², P=0.04).

Conclusion: During long term gender affirming therapy in Female to Male individuals, there was no significant deleterious effect in lipid profile, in spite of gaining weight, which could not be attributed to induction of androgen milieu. Lifestyle management was further advised. Gender affirming therapy administration to transsexual individuals is acceptably safe in the short and medium term. The data of surrogate markers of cardiovascular disease leave room for a cautious optimism. Prioritizing long term follow up studies could lead us to, urgently needed, true insight how surrogate cardiovascular risk markers translate into clinical endpoints.