Gender affirming hormonal care induces a gender-concordant gut metagenome transition in transgender individuals

Matthias Auer; Timur Liwinski; Johanna Schroder; Ina Pieknik; Christian Casar; Gunter Stalla; Undine Lang; Klitzing Alina von; Corinna Bang; Peer Briken; Christoph Schramm; Johannes Fuss

doi:10.1530/endoabs.99.EP398

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Endocrine Abstracts (2024) 99 EP398 | DOI: 10.1530/endoabs.99.EP398

ECE2024 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (383 abstracts)

Gender affirming hormonal care induces a gender-concordant gut metagenome transition in transgender individuals

Matthias Auer ¹ , Timur Liwinski ² , Johanna Schröder ³ , Ina Pieknik ⁴ , Christian Casar ⁵ , Günter Stalla ⁶ , Undine Lang ² , Alina von Klitzing ⁴ , Corinna Bang ⁷ , Peer Briken ⁴ , Christoph Schramm ⁸ & Johannes Fuss ⁸

Err

Author affiliations

¹Klinikum der Universität München, Medizinische Klinik and Poliklinik IV, Munich, Germany; ²University of Basel, Clinic for Adult Psychiatry, Basel, Switzerland; ³Medical School Hamburg, Institute for Clinical Psychology and Psychotherapy, Hamburg, Germany; ⁴University Medical Center Hamburg-Eppendorf, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany; ⁵University Medical Centre Hamburg-Eppendorf (UKE), I. Department of Medicine, Hamburg, Germany; ⁶Medicover Neuroendocrinology, Munich, Germany; ⁷Christian-Albrechts-University Kiel, Institute of Clinical Molecular Biology, Kiel, Germany; ⁸University Medical Centre Hamburg-Eppendorf, Hamburg Centre for Translational Immunology (HCTI), Hamburg, Germany

Aim: There is no data on gender-specific microbial alterations during the gender-affirming transition of trans people, along with inconsistent investigations regarding the specific impact of sex steroids on gut microbiota taxonomy and function.

Method: Our study included 36 transgender participants (17 trans women and 19 trans men). We collected stool samples before and three months post-GAHT initiation, employing shotgun metagenomic sequencing to evaluate the microbiota’s response.

Results: Taxonomically, alpha and beta diversity did not differ between trans men and trans women before transition. Moreover, transition was not associated with changes in overall alpha or beta diversity. Nevertheless, four species, namely Parabacteroides goldsteinii (FDR=0.0264), Coprococcus sp. ART55/1 (FDR=3×10^–4), Coprococcus eutactus (FDR=0.0289), and Escherichia coli (FDR=0.0019), exhibited significant abundance changes in response to hormonal treatment aligning with the participants’ affirmed gender. Our analysis revealed a statistically significant effect of gender and transition on the overall functional metagenome (R²=4.1%, P=0.0115). Single pathway analysis demonstrated alignment of the transition-related changes with the affirmed gender, particularly in fatty acid-related metabolism, which was more pronounced in the high testosterone state.

Conclusion: The study highlights distinct microbial profiles in men and women’s gut microbiomes. GAHT tends to masculinize the microbiome in trans men and feminize it in trans women. These changes could influence various health outcomes, emphasizing the importance of considering the gut microbiome in transgender health care.