Changes in Serum Testosterone and Adrenal Androgen Levels in Transgender Women With and Without Gonadectomy

BackgroundInitiating feminizing gender-affirming hormone therapy (GAHT) in transgender women causes a steep decline in serum testosterone. It is unknown if testosterone concentrations change further and whether adrenal androgen levels change during feminizing GAHT and after gonadectomy. This limits...

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Vydáno v:The journal of clinical endocrinology and metabolism Ročník 108; číslo 2; s. 331 - 338
Hlavní autoři: Collet, Sarah, Gieles, Noor C, Wiepjes, Chantal M, Heijboer, Annemieke C, Reyns, Tim, Fiers, Tom, Lapauw, Bruno, den Heijer, Martin, T'Sjoen, Guy
Médium: Journal Article
Jazyk:angličtina
Vydáno: US Oxford University Press 01.02.2023
Témata:
17β-Estradiol
Accountants
Acetic acid
Androgens
Androstenedione
Antiandrogens
Cyproterone acetate
Cyproterone Acetate - therapeutic use
Decision making
Dehydroepiandrosterone
Dehydroepiandrosterone Sulfate
Estradiol
Estrogens
Female
Gonadectomy
Hormones
Humans
Liquid chromatography
Male
Mass spectrometry
Mass spectroscopy
Sulfates
Testosterone
Transgender people
Transgender Persons
Belgium
Netherlands
gonadectomy
liquid chromatographytandem mass spectrometry
androgens
testosterone
transgender women
gender-affirming hormone therapy
ISSN:0021-972X, 1945-7197, 1945-7197
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Shrnutí:BackgroundInitiating feminizing gender-affirming hormone therapy (GAHT) in transgender women causes a steep decline in serum testosterone. It is unknown if testosterone concentrations change further and whether adrenal androgen levels change during feminizing GAHT and after gonadectomy. This limits clinical decision making in transgender women with symptoms attributed to GAHT or gonadectomy. MethodsTransgender women (n = 275) initiating estradiol and cyproterone acetate (CPA) were included at baseline, and had follow-up visits after 3 months, 12 months, and 2 to 4 years. During follow-up, 49.5% of transgender women underwent a gonadectomy. Total testosterone (TT), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), and androstenedione (A4) were measured using liquid chromatography tandem mass spectrometry. ResultsAfter 3 months of GAHT, mean TT, calculated free testosterone (cFT), and A4 decreased by 18.4 nmol/L (95% CI, −19.4 to −17.4, P < 0.001 [ie, −97.1%]), 383 pmol/L (95% CI, −405 to −362, P < 0.001 [ie, −98.3%]), and 1.2 nmol/L (95% CI, −1.4 to −1.0, P < 0.001 [ie, −36.5%]), respectively, and remained stable thereafter. DHEA and DHEAS decreased by 7.4 nmol/L (95% CI, −9.7 to −5.1 [ie, −28.0%]) and 1.8 µmol/L (95% CI, −2.2 to −1.4 [ie, −20.1%]), respectively, after 1 year and did not change thereafter. After gonadectomy, CPA therapy is stopped, which induced no further change in TT, cFT, DHEA, DHEAS, and A4 compared with those who did not undergo gonadectomy. ConclusionsOur findings confirm that after an initial drop, testosterone levels in transgender women remain stable. Adrenal androgens decrease in the first year of CPA and estrogen supplementation and remain unchanged after gonadectomy. Androgens did not change after gonadectomy and cessation of CPA. Correlates with clinical symptoms remain to be elucidated.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0021-972X
1945-7197
1945-7197
DOI:10.1210/clinem/dgac576