■性别确认激素治疗(GAHT)是变性人减少性别焦虑和改善生活质量的常用疗法。澄清GAHT的长期影响仍然是跨性别健康研究的优先事项。
■与顺性退伍军人相比,探讨性激素(雌二醇和睾丸激素)是否与跨性别退伍军人的代谢综合征发展有关。
■这次回顾展,纵向队列研究采用国际疾病分类,第九次修订和国际疾病和相关健康问题统计分类,来自退伍军人健康管理局国家数据库的性别烦躁不安的第十次修订诊断代码,以识别从2006年1月1日至2019年12月31日接受记录的女性化(雌二醇)或男性化(睾丸激素)治疗的跨女性和跨男性退伍军人,以及GAHT开始日期和代谢综合征成分相关数据可用。变性人退伍军人与顺性人所指者相匹配。
■性别确认激素治疗。
■根据体重指数计算代谢综合征z评分,收缩压,和高密度脂蛋白胆固醇水平,甘油三酯,和血糖。使用重复测量的方差分析模型,在索引日期(对应于GAHT开始)之前和之后,比较了跨性别和顺性别组的平均z得分变化。
■该队列包括1290名参与者:645名变性人(494[38.3%]跨女性,151[11.7%]跨男性)和645顺性(280[21.7%]女性,365[28.3%]男性)。索引日期的平均(SD)年龄为41.3(13.2)岁。代谢综合征z评分随着时间的推移而显着变化,并且各组之间存在显着差异。总的来说,跨男性退伍军人在指数日期之后与之前相比,平均(SEM)z分数的百分比增加最大(298.0%[57.0%];P<.001),其次是顺性女性(108.3%[27.5%];P<.001),顺性男性(49.3%[27.5%];P=0.02),和跨女性人士(3.0%[10.7%];P=.77)。
■在这项队列研究中,在顺性人和变性人退伍军人中,雌二醇与代谢综合征风险降低相关,而睾酮与风险增加相关。然而,跨男性个体患与这些激素相关的代谢综合征的风险最高,跨女性个体患代谢综合征的风险最低.这与顺性者和变性者代谢综合征危险因素的管理有关,并可能预测动脉粥样硬化性心血管疾病的风险。2型糖尿病,收缩期高血压,胰岛素抵抗,和非酒精性脂肪性肝病。
UNASSIGNED: Gender-affirming hormone treatment (GAHT) is a common therapy for transgender individuals to reduce gender dysphoria and improve quality of life. Clarifying the long-term effects of GAHT remains a priority in transgender health research.
UNASSIGNED: To explore whether sex hormones (estradiol and
testosterone) are associated with the development of metabolic syndrome in transgender veterans compared with cisgender veterans.
UNASSIGNED: This retrospective, longitudinal cohort study used International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes for gender dysphoria from the Veterans Health Administration national database to identify transfeminine and transmasculine veterans receiving documented feminizing (estradiol) or masculinizing (
testosterone) treatment from January 1, 2006, to December 31, 2019, and for whom the GAHT initiation date and metabolic syndrome component-related data were available. Transgender veterans were matched to cisgender referents.
UNASSIGNED: Gender-affirming hormone treatment.
UNASSIGNED: Metabolic syndrome z-scores were calculated based on body mass index, systolic blood pressure, and levels of high-density lipoprotein cholesterol, triglycerides, and blood glucose. Changes in mean z-scores were compared among the transgender and cisgender groups before and after the index date (corresponding to GAHT initiation) using a repeated-measures analysis of variance model.
UNASSIGNED: The cohort included 1290 participants: 645 transgender (494 [38.3%] transfeminine, 151 [11.7%] transmasculine) and 645 cisgender (280 [21.7%] female, 365 [28.3%] male). Mean (SD) age at the index date was 41.3 (13.2) years. Metabolic syndrome z-scores changed significantly over time and differed significantly across groups. Overall, transmasculine veterans had the greatest percentage increase in mean (SEM) z-scores after vs before the index date (298.0% [57.0%]; P < .001), followed by cisgender females (108.3% [27.5%]; P < .001), cisgender males (49.3% [27.5%]; P = .02), and transfeminine persons (3.0% [10.7%]; P = .77).
UNASSIGNED: In this cohort study, in both cisgender and transgender veterans, estradiol was associated with reduced metabolic syndrome risk, whereas
testosterone was associated with increased risk. However, transmasculine individuals had the greatest risk and transfeminine individuals had the lowest risk of metabolic syndrome associated with these hormones. This is relevant for the management of metabolic syndrome risk factors in cisgender and transgender individuals and to potentially predict the risk of atherosclerotic cardiovascular disease, type 2 diabetes, systolic hypertension, insulin resistance, and nonalcoholic fatty liver disease.