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J Clin Endocrinol Metab. 2018 Feb 1;103(2):790-802. doi: 10.1210/jc.2017-01559.

Effects of Sex Hormone Treatment on the Metabolic Syndrome in Transgender Individuals: Focus on Metabolic Cytokines.

Author information

1
Endocrinology, Diabetology and Internal Medicine, Max Planck Institute of Psychiatry, Munich, Germany.
2
Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany.
3
Department of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany.
4
Integrated Research and Treatment Center Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany.
5
Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
6
Department of Endocrinology and Center of Sexology and Gender, Ghent University Hospital, Ghent, Belgium.
7
Human Behavior Laboratory, Institute of Sex Research and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.

Abstract

Context:

Hormonal treatment in transgender persons affects many components of the metabolic syndrome (MS).

Objective:

To determine the role of direct hormonal effects, changes in metabolic cytokines, and body composition on metabolic outcomes.

Design, Setting, and Participants:

24 transwomen and 45 transmen from the European Network for the Investigation of Gender Incongruence were investigated at baseline and after 12 months of hormonal therapy.

Outcome Measures:

Best predictors for changes in components of MS, applying least absolute shrinkage and selection operator regression.

Results:

In transwomen, a decrease in triglyceride levels was best explained by a decrease in fat mass and an increase in fibroblast growth factor 21 (FGF-21); the decrease in total and low-density lipoprotein cholesterol levels was principally due to a decrease in resistin. A decrease in high-density lipoprotein cholesterol depended on an inverse association with fat mass. In contrast, in transmen, an increase in low-density lipoprotein cholesterol was predicted by a decrease in FGF-21 and an increase in the waist/hip ratio; a decrease in the high-density lipoprotein/total cholesterol ratio depended on a decline in adiponectin levels. In transwomen, worsened insulin resistance and increased early insulin response seemed to be due to a direct treatment effect; however, improvements in hepatic insulin sensitivity in transmen were best predicted by a positive association with chemerin, resistin, and FGF-21 and were inversely related to changes in the waist/hip ratio and leptin and adipocyte fatty acid-binding protein levels.

Conclusions:

The effects of hormonal therapy on different components of the MS are sex-specific and involve a complex interplay of direct hormonal effects, changes in body composition, and metabolic cytokine secretion.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01072825.

PMID:
29216353
DOI:
10.1210/jc.2017-01559
[Indexed for MEDLINE]

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