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Is there a need for liver enzyme monitoring in people using gender-affirming hormone therapy?

是否需要使用性别肯定激素治疗的人进行肝酶监测?

  • 影响因子:5.04
  • DOI:10.1530/EJE-20-1064
  • 作者列表:"A Stangl T","M Wiepjes C","Defreyne J","Conemans E","D Fisher A","Schreiner T","T'Sjoen G","den Heijer M
  • 发表时间:2021-04-01
Abstract

Context:Individuals with gender dysphoria can receive gender-affirming hormone therapy. Different guidelines mention a severe risk of liver injury within the first months after the start of treatment with anabolic androgenic steroids, anti-androgens, and oral contraceptives, which is potentially fatal. Objective:The incidence of liver injury in a transgender population using gender-affirming hormone therapy. Design:Multicentre prospective study with 1933 transgender individuals, who started with hormone therapy between 2010 and 2020. Methods:The following parameters were analysed before hormone therapy, after 3 months, and after 12 months of hormone therapy: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT). Both male and female reference values were considered. Liver injury was defined as either an elevation of 2× upper limit of normal (ULN) of ALP, 3× ULN of ALT, or 3× ULN of AST. Results:889 transgender women and 1044 transgender men were included in the analysis. The incidence of liver injury within 12 months after the start of hormone therapy, without attribution to alcohol abuse, medical history, or comedication was 0.1 and 0.0%. in transgender women according to female and male reference intervals respectively, and 0.6 and 0.4% in transgender men (female and male reference intervals). Conclusion:The incidence of liver injury is found to be very low. We, therefore, conclude that liver enzyme monitoring within the frame of the risk of liver injury due to hormone therapy is not necessary for a transgender population.

摘要

背景: 有性别焦虑的个体可以接受性别肯定的激素治疗。不同的指南提到在开始使用合成代谢雄激素类固醇,抗雄激素和口服避孕药治疗后的头几个月内发生肝损伤的严重风险,这可能是致命的。 目的: 使用性别肯定激素治疗的跨性别人群中肝损伤的发生率。 设计: 多中心前瞻性研究,纳入1933名变性人,他们在2010年至2020年间开始接受激素治疗。 方法: 在激素治疗前、3个月和12个月后分析以下参数: 丙氨酸氨基转移酶 (ALT) 、天冬氨酸氨基转移酶 (AST) 、碱性磷酸酶 (ALP) 和 γ-谷氨酰转移酶 (GGT)。考虑男性和女性参考值。肝损伤被定义为ALP正常上限 (ULN) 升高2倍,ALT升高3倍,AST升高3倍。 结果: 889名变性女性和1044名变性男性被纳入分析。在激素治疗开始后12个月内肝损伤的发生率为0.1和0.0%,不归因于酒精滥用、病史或粉刺。在跨性别女性中分别根据女性和男性参考区间,在跨性别男性中分别为0.6和0.4% (女性和男性参考区间)。 结论: 发现肝损伤的发生率很低。因此,我们得出结论,对于跨性别人群,在激素治疗导致肝损伤的风险范围内进行肝酶监测不是必需的。

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