Over 10% of transgender males (females transitioning to male) who take testosterone develop excessive hematocrit ranges that would put them at larger threat for a thrombotic occasion, and the most important improve in ranges happens within the first 12 months after beginning remedy, a brand new Dutch research signifies.
Erythrocytosis, outlined as a hematocrit > 0.50 L/L, is a probably severe aspect impact of testosterone remedy, say Milou Cecilia Madsen, MD, and colleagues of their article revealed on-line February 18 within the Journal of Scientific Endocrinology & Metabolism.
When hematocrit was measured twice, 11.1% of the cohort of 1073 trans males had ranges in extra of 0.50 L/L over a 20-year follow-up.
“Erythrocytosis is frequent in transgender males handled with testosterone, particularly in those that smoke, have [a] excessive BMI, and [who] use testosterone injections,” mentioned Madsen, of the VU College Medical Middle Amsterdam, the Netherlands, in an announcement from the Endocrine Society.
“An affordable first step within the care of transgender males with excessive purple blood cells whereas on testosterone is to advise them to give up smoking, change injectable testosterone to gel, and if BMI is excessive, to drop a few pounds,” she added.
First Giant Research of Testosterone in Trans Males With 20-Yr Observe-Up
Transgender males usually endure testosterone remedy as a part of gender-affirming remedy.
Secondary erythrocytosis, a situation the place the physique makes too many purple blood cells, is a frequent aspect impact of testosterone remedy that may improve the threat of thrombolic occasions, coronary heart assault, and stroke, Madsen and colleagues clarify.
That is the primary research of a big cohort of trans males taking testosterone remedy adopted for as much as 20 years. Due to the massive pattern dimension, statistical evaluation with many determinants may very well be carried out. And due to the lengthy follow-up, a transparent time relation between initiation of testosterone remedy and hematocrit may very well be studied, they word.
Individuals had been a part of the Amsterdam Cohort of Gender Dysphoria research, a big cohort of people seen on the Middle of Experience on Gender Dysphoria at Amsterdam College Medical Middle between 1972 and 2015.
Laboratory measurements taken between 2004 and 2018 had been accessible for evaluation. Trans males visited the middle each 3 to six months throughout their first 12 months of testosterone remedy and had been then monitored yearly or each different 12 months.
Lengthy-acting undecanoate injection was related to the best threat of a hematocrit stage > 0.50 L/L, and the chance of erythrocytosis in those that took long-acting intramuscular injections was about threefold larger in contrast with testosterone gel (adjusted odds ratio, 3.1).
In distinction, short-acting ester injections and oral administration of testosterone had the same threat for erythrocytosis, as did testosterone gel.
Different determinants of elevated hematocrit included smoking, medical historical past of various comorbid circumstances, and older age on initiation of testosterone (Desk 1).
Desk 1. Threat of Excessive Hematocrit Ranges for Totally different Determinants
> 0.50 L/L, aOR
> 0.52 L/L, aOR
|Medical historical past*||2.0||4.6|
|Age 40-50 at testosterone initiation†||3.1||4.9|
|BMI ≥ 30 kg/m2‡||3.1||4.6|
aOR = adjusted odds ratio; BMI = physique mass index.
In distinction, “larger testosterone ranges per se weren’t related to an elevated odds of hematocrit > 0.50 L/L”, the authors word.
Present Recommendation for Trans Males Based mostly on Previous Steerage for Hypogonadism
The authors say present recommendation for trans males relies on suggestions for testosterone-treated hypogonadal cis males (these assigned male at delivery) from 2008, which advises a hematocrit > 0.50 L/L has a moderate-high threat of opposed end result. For ranges > 0.54 L/L, cessation of testosterone remedy, a dose discount, or therapeutic phlebotomy to scale back the chance of opposed occasions is suggested. For ranges 0.50-0.54 L/L, no clear recommendation is given.
However questions stay as as to if these tips are relevant to trans males as a result of the period of testosterone remedy is for much longer in trans males and hormone remedy usually can’t be discontinued with out inflicting misery.
In the meantime, hematology tips point out an higher restrict for hematocrit for cis females of 0.48 L/L.
“It may very well be argued that the higher restrict for cis females ought to be utilized, as trans males are born with feminine genetics,” the authors say.
“It is a topic for additional analysis,” they observe.
Period of Testosterone Remedy Impacts Threat of Erythrocytosis
Within the research, researchers discovered that longer period of testosterone remedy elevated the chance of creating hematocrit ranges > 0.50 L/L.
For instance, after 1 12 months, the cumulative incidence of erythrocytosis was 8%; after 10 years, it was 38%; and after 14 years, it was 50%.
Till extra particular steering is developed for trans males, if hematocrit ranges rise to 0.50-0.54 L/L, they recommend taking “cheap” steps to forestall an additional improve:
Take into account switching sufferers who use injectable testosterone to transdermal merchandise.
Advise sufferers with a BMI > 25 kg/m2 to drop a few pounds to achieve a BMI of 18.5-25 kg/m2.
Advise sufferers to give up smoking.
Pursue remedy optimization for persistent lung illness or sleep apnea.
The research had no exterior funding. The authors have reported no related monetary relationships.
J Scientific Endocrinol Metab. Revealed on-line February 18, 2021. Summary
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