Abstract:
A 16-year-old trans female patient presented to our Gender Health Program for gender-affirming care. Her intake evaluation revealed signs of hepatocellular injury and fibrosis concerning for metabolic dysfunction-associated steatohepatitis (MASH) and she was referred to a Pediatric Hepatologist. Subsequent delays in initiating hormone therapy caused a decline in her mental health, and she began experiencing suicidal ideations. Gender-affirming hormone therapy has been shown to significantly reduce depressive symptoms and suicidal ideations in transgender and gender diverse youth, and studies in animal models suggest improvement in hepatic steatosis in response to estrogen. A multidisciplinary meeting with Gender Health, Psychiatry, and Hepatology appropriately weighed the benefits of life-saving hormone therapy and the possibility of an improvement in her comorbid liver condition with the risk of further liver damage from estrogen therapy. The teams and the patient agreed to start estradiol with subsequent resolution of laboratory and radiographic evidence of MASH.
摘要:
一名16岁的跨性别女性患者向我们的性别健康计划提出了性别确认护理。她的摄入量评估显示,与代谢功能障碍相关的脂肪性肝炎(MASH)有关的肝细胞损伤和纤维化的迹象,她被转介给儿科肝病专家。随后开始激素治疗的延误导致她的心理健康下降,她开始有自杀念头.性别确认激素疗法已被证明可以显着减少变性和性别多样化青年的抑郁症状和自杀意念,在动物模型中的研究表明,雌激素对肝脂肪变性的反应有所改善。与性别健康的多学科会议,精神病学,和肝病学适当权衡了挽救生命的激素治疗的益处,以及她的合并症肝脏状况改善的可能性,以及雌激素治疗导致进一步肝损害的风险。研究小组和患者同意开始使用雌二醇,随后解决了MASH的实验室和影像学证据。