Hyperandrogenism-related metabolic changes in drug-naive transmen compared to cisgender women: A case-controlled study

Pnar Erel; Onur Elbasan; Neşe Yorguner; Eren Imre; Ozlem Ustay

doi:10.1530/endoabs.90.P177

Introduction: The etiology of gender dysphoria is still unclear. Although prior studies have shown trans men have higher androgen levels than cisgender women, they all concluded unselected populations. Our purpose to perform this study is to evaluate transmen’s hormone profile and metabolic status to compare cisgender women in a more selected population. This is the first case-controlled study to compare anthropometric, metabolic, and endocrinological parameters of drug-naïve transmen with those of cisgender women.

Methods: We designed this study as a single-center observational cohort study. We included 70 drug-naive transmen, and the control group comprised 34 healthy cisgender women. We measured and compared hormone profiles and metabolic parameters in the two groups.

Results: Of the 70 transmen individuals, 16 (22.85%) met Rotterdam criteria and were diagnosed with polycystic ovary syndrome (PCOS), 4 individuals in the control group met the criteria (11.7%). Although we matched body mass index in the groups, total testosterone, free androgen index, androstenedione, 17-hydroxyprogesterone, muscle strength, triglyceride, and homeostatic model assessment of insulin resistance levels were significantly higher in the trans men than in the cisgender women (P<0.05). Even after were excluded PCOS patients, hyperandrogenemia was apparent in the transmen.

Table 1 Comparison of the parameters after patients with polycystic ovary syndrome excluded
	Transmen(n=54)	Ciswomen(n=30)	p
Age(Years)	25.09±5.02	26.86±3.81	0.044
BMI	22.88±3.48	23.71±5.39	0.863
Waist circumference(cm)	77.87±9.56	73.21±11.12	0.009
F-G Score	3.15±2.28	3.76±2.52	0.341
Fasting glucose(mg/dl)	83.77±7.41	82.44±7.37	0.477
Triglyceride(mg/dl)	86.75±66.40	57.86±19.81	0.002
Total cholesterol(mg/dl)	171.53±31.56	176.70±19.26	0.436
LDL(mg/dl)	104.30±25.01	105.30±18.10	0.595
HDL(mg/dl)	53.07±8.56	59.83±11.06	0.005
IGF-1(µg/l)	188.30±57.09	161.55±49.84	0.024
FSH(U/l)	7.73±2.33	7.40±2.20	0.881
LH(U/l)	6.03±2.16	6.25±2.36	0.798
Estradiol(ng/l)	48.39±18.11	58.21±35.15	0.132
Total testosterone(µg/l)	0.59±0.28	0.43±0.18	0.004
SHBG(nmol/l)	58.27±22.32	67.03±29.88	0.227
FAI	1.25±0.97	0.81±0.44	0.032
Androstenedione(µg/l)	4.02±5.91	2.40±0.87	0.012
DHEAS(µg/l)	268.98±113.95	202.81±72.10	0.008
Prolactin(µg/l)	17.48±9.90	19.43±10.38	0.384
17-OH progesterone(µg/l)	1.25±0.66	0.81±0.33	0.005
HsCRP(mg/l)	1.88±1.87	1.73±2.02	0.465
Mean muscle strength	26.37±4.37	24.51±3.96	0.087
HOMA-IR	2.14±0.90	1.80±1.48	0.011
HOMA-β	180.52±85.80	159.39±99.88	0.124
AUC(Glucose)	203.61±39.68	197.59±51.47	0.571
AUC(Insulin)	94.75±47.75	87.14±86.54	0.032
LDL:Low Density Lipoprotein, HDL:High Density Lipoprotein, IGF-1:Insulin Like Growth Factor, SHBG: Sex Hormone Binding Globuline, FAI:Free Androgen Index, DHEAS:Dihidroepiandrosetenedione Sulfate, HsCRP:High Sensitive-C Reactive Protein, HOMA-IR:Homeostatic Model Assessment for Insulin Resistance, AUC:Area Under the Curve

Conclusions: Our study showed that transmen have clearly higher androgen levels, which may have been the reason for metabolic changes compared to cisgender women. But the main reason for hyperandrogenism in drug-naïve transmen is still not known, and more comprehensive studies are needed.

Endocrine Abstracts

P177