Metabolic and functional changes in transgender individuals following cross-sex hormone treatment: Design and methods of the GEnder Dysphoria Treatment in Sweden (GETS) study

Wiik, Anna; Andersson, Daniel P.; Brismar, Torkel B.; Chanpen, Setareh; Dhejne, Cecilia; Ekström, Tomas J.; Flanagan, John N.; Holmberg, Mats; Kere, Juha; Lilja, Mats; Lindholm, Maléne E.; Lundberg, Tommy R.; Maret, Eva; Melin, Michael; Olsson, Sofie M.; Wåhlén, Kerstin; Arver, Stefan; Gustafsson, Thomas

doi:10.1016/j.conctc.2018.04.005

Cited by 29 publications

(21 citation statements)

References 44 publications

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“…The use of gender‐affirming treatment results in improved quality of life for transgender patients, such that it may be considered unethical to do placebo‐controlled trials . Multiple studies are in progress to address the many questions and long‐term health effects associated with transgender treatments …”

Section: Resultsmentioning

confidence: 99%

“…58 Multiple studies are in progress to address the many questions and long-term health effects associated with transgender treatments. 59,60 Although the risks for some adverse effects are elevated, absolute risks are not so high that hormone use should be denied in most transgender patients. Different risks and levels of concern are associated with transitioning.…”

Section: Con Clus Ionmentioning

confidence: 99%

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Transgender patients and the role of the coagulation clinician

Connors

2019

Journal of Thrombosis and Haemostasis

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The medical care of transgender patients relies on the use of sex hormones to develop and maintain the physical characteristics consistent with gender identity as the first step in transitioning. Hormonal therapy is usually continued indefinitely, even following gender‐affirming surgeries. The use of hormonal treatments is associated with a multitude of positive effects as well as complications and side effects. The risk of venous thromboembolism (VTE) is a major concern. Transgender patients are often referred to coagulation specialists for advice regarding an individual patient's risk for VTE, especially if there is a personal or family history of VTE. Coagulation specialists need to be familiar with endocrine therapy including the goals of treatment and the VTE risks associated with currently used hormone regimens. We will review common referral questions and the available data and their limitations for the use of hormonal therapy in transgender patients focusing on the risk of VTE.

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Section: Resultsmentioning

confidence: 99%

Section: Con Clus Ionmentioning

confidence: 99%

Transgender patients and the role of the coagulation clinician

Connors

2019

Journal of Thrombosis and Haemostasis

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“…This challenge is also confounded by differences in formulations of hormone therapy, age at initiation of therapy, and comorbid conditions that, by themselves, may present as risk factors for adverse cardiovascular events. To date, there are no published longitudinal studies that have included data on trans persons prior to and serially after treatment into older age, however, the Gender Dysphoria Treatment in Sweden (GETS) study is designed to do so …”

Section: Transgendermentioning

confidence: 99%

“…To date, there are no published longitudinal studies that have included data on trans persons prior to and serially after treatment into older age, however, the Gender Dysphoria Treatment in Sweden (GETS) study is designed to do so. 67 Few studies have specifically addressed potential hormonedrug interactions except for managing trans patients with sickle cell disease, 68 and treatments for HIV. 69 Although both trans men and trans women report reductions in anxiety, depression and perceived stress when treated with hormone therapy, 61 individuals using pharmaceutical treatments for other conditions prior to initiation of the steroid hormones may require adjustment for those medications.…”

Section: Tr Ansg Endermentioning

confidence: 99%

Individualized medicine: Sex, hormones, genetics, and adverse drug reactions

Moyer

Matey

Miller

2019

Pharmacology Res & Perspec

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Clinically relevant adverse drug reactions differ between men and women. The underlying physiological and pharmacological processes contributing to these differences are infrequently studied or reported. As gene expression, cellular regulatory pathways, and integrated physiological functions differ between females and males, aggregating data from combined groups of men and women obscures the ability to detect these differences. This paper summarizes how genetic sex, that is, the presence of sex chromosomes XY for male or XX for female, and the influence of sex hormones affect transporters, receptors, and enzymes involved in drug metabolism. Changing levels of sex steroids throughout life, including increases at puberty, changes with pregnancy, and decreases with age, may directly and indirectly affect drug absorption, distribution, metabolism, and elimination. The direct and indirect effects of sex steroids in the form of exogenous hormones such as those used in hormonal contraceptives, menopausal hormone treatments, transgender therapy, and over‐the‐counter performance enhancing drugs may interfere with metabolism of other pharmaceuticals, and these interactions may vary by dose, formulation, and mode of delivery (oral, injection, or transdermal) of the steroid hormones. Few drugs have sex‐specific labeling or dosing recommendations. Furthermore, there is limited literature evaluating how the circulating levels of sex steroids impact drug efficacy or adverse reactions. Such research is needed in order to improve the understanding of the impact of sex hormones on pharmacological therapies, particularly as medicine moves toward individualizing treatments.

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“…This study was part of a single-center observational cohort study [20]. Examinations were conducted at 4 time points ( Fig.…”

Section: General Designmentioning

confidence: 99%

Muscle strength, size and composition following 12 months of gender-affirming treatment in transgender individuals: retained advantage for the transwomen

Wiik

Lundberg

Andersson

et al. 2019

Preprint

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Objectives: This study explored the effects of gender-affirming treatment, which includes inhibition of endogenous sex hormones and replacement with cross-sex hormones, on muscle function, size and composition in 11 transwomen (TW) and 12 transmen (TM). Methods:Isokinetic knee extensor and flexor muscle strength was assessed at baseline (T00), 4 weeks after gonadal suppression of endogenous hormones but before hormone replacement (T0), and 3 (T3) and 11 (T12) months after hormone replacement. In addition, at T00 and T12, we assessed lower-limb muscle volume using MRI, and cross-sectional area (CSA) and radiological density using CT. Results: Thigh muscle volume increased (15%) in TM, which was paralleled by increased quadriceps CSA (15%) and radiological density (6%). In TW, the corresponding parameters decreased by -5% (muscle volume) and -4% (CSA), while density remained unaltered. The TM increased strength over the assessment period, while the TW generally maintained or slightly increased in strength. Baseline muscle volume correlated highly with strength (R>0.75), yet the relative change in muscle volume and strength correlated only moderately (R=0.65 in TW and R=0.32 in TM). The absolute levels of muscle volume and knee extension strength after the intervention still favored the TW. Conclusion: Cross-sex hormone treatment markedly affects muscle strength, size and composition in transgender individuals. Despite the robust increases in muscle mass and strength in TM, the TW were still stronger and had more muscle mass following 12 months of treatment. These findings add new knowledge that could be relevant when evaluating transwomen's eligibility to compete in the women's category of athletic competitions. 14

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Metabolic and functional changes in transgender individuals following cross-sex hormone treatment: Design and methods of the GEnder Dysphoria Treatment in Sweden (GETS) study

Cited by 29 publications

References 44 publications

Transgender patients and the role of the coagulation clinician

Transgender patients and the role of the coagulation clinician

Individualized medicine: Sex, hormones, genetics, and adverse drug reactions

Muscle strength, size and composition following 12 months of gender-affirming treatment in transgender individuals: retained advantage for the transwomen

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