Cross-Sex Hormone Therapy Alters the Serum Lipid Profile: A Retrospective Cohort Study in 169 Transsexuals

Abstract

Introduction Cross-sex hormone therapy (CSHT) is known to lead to alterations in the serum lipid profile. However, the available reports in the literature are problematic, because of methodological limitations. AIMS: To assess changes in the fasting serum lipid profile during CSHT, including long-term follow-up. Methods Retrospective chart analysis of all 89 male-to-female (MtF) and 80 female-to-male (FtM) transsexuals who underwent standard CSHT at the Department of Gynecologic Endocrinology of the Medical University of Vienna (university hospital, tertiary care center), from 1995 to 2009. Main Outcome Measures The results of the lipid profile were analyzed, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and the TC-to-HDL ratio, at the time of treatment initiation (time point “0”) and at 3, 12, 24, and 60 months after the start of CSHT. Results The mean age of patients about to commence CSHT was 35.7 ± 11.4 years (MtF) and 26.0 ± 6.3 years (FtM). For MtF transsexuals, consistent follow-up for 24 and 60 months was available in 83 (93.3%) and 58 (65.2%) patients, respectively; for FtM transsexuals, follow-up was available in 57 (71.3%) and 39 (48.8%) patients, respectively. When testing for an association between the lipid parameters and the time after treatment initiation, significant increases for TG (P < 0.001), TC (P = 0.021), and HDL (P = 0.001) were found for MtF transsexuals, whereas TG, TC, and LDL (P < 0.001) increased and HDL (P < 0.001) decreased in FtM patients. Conclusion Both MtF and FtM transsexuals experience alterations in the serum lipid profile because of CSHT, with the changes in FtM patients possibly more relevant in terms of atherogenesis.

Priorities for transgender medical and healthcare research

“…Similar studies of testosterone therapy in transgender men report decreases in HDL cholesterol, increases in triglycerides and either no change or increase in LDL cholesterol [30,31,33,34]. Cross-sectional studies, retrospective cohort studies, and a systematic literature review all have similar findings [21,26,32,35]. …”

“…Short term (6–12 month) prospective studies of estrogen therapy among transgender women show increases in HDL cholesterol and triglycerides [31], a finding also reported in cross sectional and retrospective cohort studies [21,32]. Similar studies of testosterone therapy in transgender men report decreases in HDL cholesterol, increases in triglycerides and either no change or increase in LDL cholesterol [30,31,33,34].…”

Gender impact on the correlation between thyroid function and serum lipids in patients with differentiated thyroid cancer

“…By contrast, considering estrogen, Wranicz et al (29) revealed a significantly positive correlation between estradiol levels and serum TC, TG and LDL-C levels. Ott et al (30) performed a study to explore the change of serum lipid levels of transsexuals after cross-gender therapy, and significant increases of TC, TG and HDL-C were identified in male to female transsexuals. Another study demonstrated that the estradiol concentration in males had a significant negative correlation with HDL-C concentration and a significant positive correlation with the TG level (31).…”

BMI, body fat mass and plasma leptin level in relation to cardiovascular diseases risk factors among adolescents in Taitung

“…To date, the mechanisms of sex-related differences in lipid homeostasis is still unclear, but a strong association between lipid metabolism and female hormone is found [27]. A cross-sex hormone therapy study including 169 transsexuals reported that sex hormone therapy such as transdermal estradiol patch may increase the levels of serum triglycerides, total cholesterol and HDL-cholesterol in male-to-female transsexuals [28]. Although another early human study reported that there was no significant correlation between estradiol and leptin levels among 48 obese and nonobese children [29], the mechanisms between sex hormone, lipid metabolism, and leptin, still needs further studies.…”