OR52-6 Endocrine treatment of transsexual persons: a multicenter prospective study using a standardized treatment protocol

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR52-Reproductive Axis Determination, Development & Transgender Medicine
Basic/Clinical
Tuesday, June 18, 2013: 9:15 AM-10:45 AM
Presentation Start Time: 10:30 AM
Room 104 (Moscone Center)
Katrien Wierckx*1, Eva Van Caenegem1, Youri Taes1, Jean-Marc Kaufman1, Thomas Schreiner2 and Guy G T'Sjoen1
1Ghent University Hospital, Ghent, Belgium, 2Rikshospitalet, Grimstad, Norway
Introduction: Our knowledge concerning effects and side effects of cross-sex hormone therapy is limited, mainly due to the low prevalence, small number of subjects treated in each centre, lack of prospective studies and wide variations in treatment modalities. We conducted a prospective multi-centre intervention study in 4 large European institutions with established gender teams (Ghent, Oslo, Amsterdam, and Florence). The main aim of the present study is to investigate effects, side effects and adverse events of standardized cross-sex hormonal therapies at set time points in a well-described cohort of transsexual persons.

Subjects: We present data of 45 transmen and 42 transwomen have been in follow-up for at least 1 year of cross-sex hormonal treatment (Ghent and Oslo).

Methods: Standardized treatment regimens involved testosterone undecanoate IM 1000mg/12 weeks for transmen. Estradiol valerate, 4mg daily (or transdermal 100µg/3days for patients older than 45 years) combined with cyproterone acetate 50mg daily for transwomen. Biochemical testing, waist-hip ratio, blood pressure, body fat and lean mass (dual X-ray absorptiometry), Gradual Acne Grading Scale, Ferriman and Gallway classification and newly developed questionnaires assessing side effects of hormonal therapy.

Results: We observed no deaths, cardiovascular events, osteoporotic fractures, venous thrombosis and/or pulmonary embolism nor prolactinoma during the study.Transwomen experienced a significant increase in breast tenderness, hot flashes, emotionality and decreased sex drive (all P≤0.01). They gained fat mass and lost lean and muscle mass (all P≤0.001). Fasting insulin, prolactin levels increased; waist-hip ratio, mean arterial blood pressure, total cholesterol (CH), LDL-CH, and triglycerides decreased.Transmen reported significant higher sexual desire and more voice instability (all P≤0.01). Significant increase in acne scores and body hair development was observed. Testosterone treatment induced higher lean body mass and muscle mass and a lower total body fat (all P≤0.01). Total CH, LDL-CH remained unchanged whereas a decrease in HDL-CH and increase in triglycerides was observed (P≤0.015).

Conclusions: Current treatment modalities carry a low risk for adverse events at short time follow-up. Cross-sex hormone treatment induced both desired and undesired effects in transwomen and transmen. Anti-androgen and estrogen therapy increased fat mass but decreased cholesterol levels. Testosterone treatment induced a less favourable lipid profile in transmen.

Nothing to Disclose: KW, EV, YT, JMK, TS, GGT

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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