Changes in Serum Testosterone and Adrenal Androgen Levels in Transgender Women With and Without Gonadectomy.
androgens
gender-affirming hormone therapy
gonadectomy
liquid chromatographytandem mass spectrometry
testosterone
transgender women
Journal
The Journal of clinical endocrinology and metabolism
ISSN: 1945-7197
Titre abrégé: J Clin Endocrinol Metab
Pays: United States
ID NLM: 0375362
Informations de publication
Date de publication:
17 01 2023
17 01 2023
Historique:
received:
07
07
2022
pubmed:
7
10
2022
medline:
20
1
2023
entrez:
6
10
2022
Statut:
ppublish
Résumé
Initiating 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. Transgender 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. After 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. Our 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.
Sections du résumé
BACKGROUND
Initiating 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.
METHODS
Transgender 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.
RESULTS
After 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.
CONCLUSIONS
Our 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.
Identifiants
pubmed: 36201493
pii: 6750024
doi: 10.1210/clinem/dgac576
pmc: PMC9844963
doi:
Substances chimiques
Androgens
0
Testosterone
3XMK78S47O
Androstenedione
409J2J96VR
Cyproterone Acetate
4KM2BN5JHF
Dehydroepiandrosterone
459AG36T1B
Dehydroepiandrosterone Sulfate
57B09Q7FJR
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
331-338Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society.
Références
Endocr Rev. 2019 Feb 1;40(1):97-117
pubmed: 30307546
Endocrinol Metab Clin North Am. 2015 Jun;44(2):275-96
pubmed: 26038201
J Urol. 2012 May;187(5):1601-6
pubmed: 22425112
J Obstet Gynaecol. 2018 Feb;38(2):231-235
pubmed: 28903616
Fertil Steril. 2002 Apr;77 Suppl 4:S77-82
pubmed: 12007908
J Clin Endocrinol Metab. 1999 Oct;84(10):3666-72
pubmed: 10523012
Sex Dev. 2018;12(1-3):50-94
pubmed: 29439271
Cancers (Basel). 2021 May 21;13(11):
pubmed: 34063736
Mol Pharmacol. 2003 May;63(5):1012-20
pubmed: 12695529
J Clin Endocrinol Metab. 2017 Nov 1;102(11):3869-3903
pubmed: 28945902
J Clin Endocrinol Metab. 2023 Jan 17;108(2):331-338
pubmed: 36201493
J Clin Endocrinol Metab. 2013 Jul;98(7):3058-67
pubmed: 23780369
J Clin Endocrinol Metab. 2019 Oct 1;104(10):4660-4666
pubmed: 31498871
Horm Res. 1984;20(2):108-15
pubmed: 6237971
J Sex Med. 2018 Sep;15(9):1357-1363
pubmed: 30224022
J Sex Med. 2016 Jun;13(6):994-9
pubmed: 27162190
Lancet Diabetes Endocrinol. 2017 Apr;5(4):291-300
pubmed: 27916515
Fertil Steril. 2002 Apr;77(4):660-5
pubmed: 11937111
Nat Rev Urol. 2019 Feb;16(2):121-139
pubmed: 30375495
Obstet Gynecol. 1997 Dec;90(6):995-8
pubmed: 9397118
J Clin Endocrinol Metab. 2017 Apr 1;102(4):1161-1173
pubmed: 28324103
Contraception. 2003 Jan;67(1):25-32
pubmed: 12521654
J Clin Oncol. 2014 Nov 20;32(33):3705-15
pubmed: 25311217
Minerva Ginecol. 2013 Dec;65(6):641-51
pubmed: 24346252
J Steroid Biochem. 1989 Oct;33(4A):531-4
pubmed: 2530403
LGBT Health. 2017 Oct;4(5):328-336
pubmed: 28880825
BMC Urol. 2017 Aug 29;17(1):70
pubmed: 28851333
Clin Endocrinol (Oxf). 2016 Aug;85(2):239-46
pubmed: 26932202
Clin Endocrinol (Oxf). 1995 Oct;43(4):415-21
pubmed: 7586614
Clin Chim Acta. 2016 Feb 15;454:112-8
pubmed: 26778410
J Clin Endocrinol Metab. 1978 Sep;47(3):581-6
pubmed: 233676
Andrologia. 2016 Dec;48(10):1130-1137
pubmed: 26888610
Fertil Steril. 1990 Jan;53(1):40-4
pubmed: 2136835
J Androl. 2012 Nov-Dec;33(6):1233-8
pubmed: 22492843
J Clin Endocrinol Metab. 2021 Sep 27;106(10):e3936-e3945
pubmed: 34125226
Clin Chim Acta. 2017 Jul;470:115-124
pubmed: 28479316
J Clin Endocrinol Metab. 2010 Oct;95(10):4542-8
pubmed: 20926540
Clin Chim Acta. 2015 Oct 23;450:227-32
pubmed: 26327459
J Clin Endocrinol Metab. 1995 Nov;80(11):3201-8
pubmed: 7593427
Trends Psychiatry Psychother. 2021 Jan-Mar;43(1):37-46
pubmed: 33681906
Clin Endocrinol (Oxf). 2021 May;94(5):743-752
pubmed: 32926454
J Sex Med. 2022 Apr;19(4):553-568
pubmed: 35227621
J Pediatr. 1977 May;90(5):766-70
pubmed: 140222
Clin Chim Acta. 2019 Aug;495:198-204
pubmed: 30981845
J Clin Endocrinol Metab. 2004 Feb;89(2):534-43
pubmed: 14764758
J Clin Endocrinol Metab. 2012 Feb;97(2):408-15
pubmed: 22162468
Eur J Contracept Reprod Health Care. 2011 Dec;16(6):458-67
pubmed: 21942708
J Clin Endocrinol Metab. 2007 Feb;92(2):405-13
pubmed: 17090633
J Womens Health (Larchmt). 2012 Feb;21(2):161-9
pubmed: 22011208
Eur J Endocrinol. 2008 Mar;158(3):393-9
pubmed: 18299474
Horm Metab Res. 2006 Mar;38(3):183-7
pubmed: 16673210
J Clin Med. 2022 Mar 24;11(7):
pubmed: 35407392