Favourable short-term safety profile for cross-sex hormones in transgender adolescents

By Eleanor McDermid
Pediatrics 2017; Advance online publication
28 April 2017

medwireNews: Metabolic changes in transgender adolescents receiving cross-sex hormone therapy are consistent with those previously reported in adults and support the short-term safety of the treatment, say researchers.

Jason Jarin (University of Texas Southwestern, Dallas, USA) and study co-authors assessed data from 116 adolescents who underwent treatment at four US centres and had follow-up for a maximum of 35 months. “Risk factors for adult metabolic disease commonly emerge in adolescence, highlighting the importance of determining the effects of sex steroid administration in this population,” they say.

Seventy-two of the patients were affirmed male (ie, born female but transitioning to male). In line with data from adults, their body mass index increased significantly during treatment, from a baseline average of 26.0 to 27.3 kg/m2 after more than 6 months of treatment, as did their haemoglobin and haematocrit levels, from 13.5 to 15.0 g/dL and from 39.4% to 44.5%, respectively.

There was also a significant reduction in high-density lipoprotein cholesterol levels, but given the inconclusive results reported for lipid levels in adults, the researchers believe that more study is needed. Other parameters measured included blood pressure, serum urea nitrogen, creatinine and prolactin, but none of these significantly changed during follow-up.

Most parameters that changed did so within the first 3 months after treatment initiation, supporting early monitoring. However, the findings also indicate “that frequent laboratory surveillance beyond blood counts and lipids may be of little benefit because no significant changes were found beyond these parameters to support this practice”, write Jarin and team in Pediatrics.

Almost no metabolic or cardiovascular changes were observed among the 44 affirmed female patients, except for the expected changes in sex hormones. Alanine aminotransferase levels significantly decreased 4–6 months after treatment initiation, but this “was not clinically significant because the levels remained within normal range”, says the team.

“These results indicate that affirmed female adolescents taking estrogen may not require laboratory testing as frequently as their affirmed male counterparts, at least in the short-term”, the researchers suggest.

Their exception to this advice is for patients with multiple medical issues, due to an “isolated but clinically important event involving hyponatremia and mild hyperkalemia” in a patient with comorbidities including HIV and secondary syphilis, which “may have contributed to these metabolic derangements.”

The team concludes: “This study found patterns in metabolic and cardiovascular parameters that support the short-term safety of cross-sex hormone therapy in adolescents.”

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