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Improving Hormone Levels in
Transgenders Receiving Hormone Therapy
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IAS 2021, 11th IAS Conference on HIV Science, July 18-21, 2021
Mark Mascolini
One third of transgender women receiving feminizing hormone therapy (FHT) attained target-level hormones, while 13% of transgender men reached optimal testosterone levels in a real-world analysis of 1700 transgender people in Thailand [1]. The proportion of people with optimal hormone levels rose over time in both transgender groups.
Researchers at Bangkok's Institute of HIV Research and Innovation defined gender dysphoria as "discomfort or distress caused by a discrepancy between a person's gender identity and sex assigned at birth." Strategies to cope with this problem include change in gender expression and role, surgery, psychotherapy, and hormone therapy.
This analysis focused on gender-affirming hormone therapy (GAHT) used to bring secondary sex characteristics more in line with a person's gender identity: feminizing hormone therapy (FHT) for transgender women and masculinizing hormone therapy (MHT) for transgender men. Only close monitoring can ensure an optimal response while avoiding adverse events like venous thrombosis, gallstones, high transaminase levels, and high triglycerides, the researchers caution. Furthermore, FHT can have interactions with antiretrovirals.
The transgender study population attended Bangkok's Tangerine Clinic between November 2015 and June 2020. Transgender women reported current use of FHT and had blood tested for estradiol and testosterone. Transgender men reported current use of MHT and had blood tested for testosterone. The investigators assessed baseline metabolic parameters plus baseline and available 12-month estradiol and testosterone. Target testosterone levels were 400 to 700 ng/dL for transgender men and less than 50 ng/dL for transgender women. The estradiol target for transgender women was 100 to 200 pg/mL.
The study included 1534 transgender women, 5% with HIV and 2.5% with orchiectomy (testicle removal). Two thirds of these women, 65.8%, had neither estradiol nor testosterone within the target range, 31.6% had only optimal testosterone levels, 0.7% had only optimal estradiol levels, and 1.8% had optimal estradiol and testosterone levels. Median (intraquartile range, IQR) estradiol stood at 29 pg/mL (IQR 14.3 to 45.3), while median testosterone measured 298.5 ng/dL (IQR 22 to 646). Among 1105 people with available hormone therapy data, 33.2% took only estrogen, 33% took only an antiandrogen, 4.5% took progesterone, 28.3% took ethinylestradiol (EE) plus cyproterone acetate, 0.8% took EE plus DRPS, and 0.1% took EE plus GSD.
Among 187 women with neither estradiol nor testosterone within the target range at baseline, increasing numbers attained target-range hormones over time: 22 at month 3, 50 at month 6, 53 at month 9, and 78 at month 12. Among 115 women with one or both hormones within the target range at baseline, numbers with target-range levels also rose over time: 9 at month 3, 32 at month 6, 31 at month 9, and 117 at month 12.
The Bangkok team analyzed 200 transgender men, none of whom had genital surgery and none with HIV. At the baseline visit almost three quarters, 70.5%, had suboptimal testosterone levels, 16.5% had supraoptimal levels, and 13% had optimal levels. Median estradiol stood at 56 pg/mL (IQR 35 to 108) and median testosterone at 45.5 ng/dL (IQR 32.5 to 531.6).
Among 108 men with suboptimal testosterone at baseline, 11 reached an optimal level between months 3 and 6, and 107 attained an optimal level between months 6 and 12. Among 25 men with supraphysiologic testosterone at baseline, 5 reached an optimal level between months 3 to 6, as did 22 between months 6 and 12. And among 19 men who had optimal testosterone at baseline, 5 had an optimal level between months 3 and 6, as did 19 between months 6 and 12.
The researchers concluded that growing proportions of transgender women and men with optimal hormone levels over time confirm that positive hormone outcomes can be attained with supervised gender-affirming hormone therapy at a transgender-competent health care facility.
References
1. Hiransuthikul A, Janamnuaysook R, Getwongsa P, et al. Hormone levels among transgender women and transgender men in a transgender-led, integrated, gender-affirming care and sexual health service at Tangerine Clinic in Bangkok, Thailand: a real-world analysis. IAS 2021, 11th IAS Conference on HIV Science, July 18-21, 2021. Abstract OALC0602.
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