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Ovarian, breast, and metabolic changes induced by androgen treatment in transgender men
Fertility and Sterility ( IF 6.6 ) Pub Date : 2021-09-02 , DOI: 10.1016/j.fertnstert.2021.07.1206
Paul Pirtea 1 , Jean Marc Ayoubi 1 , Stephanie Desmedt 2 , Guy T'Sjoen 3
Affiliation  

Gender-affirming hormone therapy (GAHT) is often provided to transgender people. In this review of the literature, the current knowledge of ovarian, breast, and metabolic changes (body composition, insulin resistance, bone density, cardiovascular risk factors such as lipids, blood pressure, and hematocrit) observed following GAHT in adult transgender men is discussed.

A body of literature concurs to describe that long-term androgen therapy in transgender men exerts atrophic effects on the breast. There is currently no evidence of an increased risk of breast cancer. Long-term testosterone treatment induces ovarian effects that become visible after 6 months of therapy. These changes consist of both macroscopic and microscopic alterations of ovarian morphology that mimic the typical ovarian aspect encountered in women with polycystic ovary syndrome but without an effect on antral follicle count. Metabolic effects of long-term androgen treatment in transgender men put them at par with cisgender men in terms of lipid profile, insulin resistance, and overall mortality. Body composition changes as desired after testosterone administration in most transgender men, and insulin resistance decreases with virilization. There are no detrimental effects on bone mineral density. Cardiometabolic risk and morbidity data are currently reassuring, even if certain studies show conflicting results. An increase in blood pressure and a decrease in high-density lipoprotein cholesterol have been reported as risk factors, whereas polycythemia is rare and treatable. Most available data are observational and based on biochemical markers instead of the more direct measures of cardiovascular damage. An explanation for these observed changes is mostly lacking. Psychological stress and lifestyle factors are often forgotten in a much needed integrated approach.



中文翻译:

跨性别男性雄激素治疗引起的卵巢、乳房和代谢变化

性别肯定激素疗法 (GAHT) 通常提供给跨性别者。在这篇文献综述中,讨论了成年跨性别男性在接受 GAHT 后观察到的卵巢、乳房和代谢变化(身体成分、胰岛素抵抗、骨密度、心血管危险因素,如血脂、血压和血细胞比容)的当前知识.

大量文献一致认为,跨性别男性的长期雄激素治疗会对乳房产生萎缩作用。目前没有证据表明患乳腺癌的风险会增加。长期睾酮治疗会诱发卵巢效应,在治疗 6 个月后变得可见。这些变化包括卵巢形态的宏观和微观改变,模拟多囊卵巢综合征女性遇到的典型卵巢方面,但对窦卵泡计数没有影响。长期雄激素治疗对跨性别男性的代谢作用使他们在血脂、胰岛素抵抗和总体死亡率方面与顺性别男性持平。大多数跨性别男性在服用睾酮后身体成分会根据需要发生变化,并且胰岛素抵抗会随着男性化而降低。对骨矿物质密度没有不利影响。心脏代谢风险和发病率数据目前令人放心,即使某些研究显示出相互矛盾的结果。据报道,血压升高和高密度脂蛋白胆固醇降低是危险因素,而红细胞增多症是罕见且可治疗的。大多数可用数据是观察性的,基于生化标志物,而不是更直接的心血管损伤测量。对这些观察到的变化的解释大多缺乏。心理压力和生活方式因素往往在急需的综合方法中被遗忘。据报道,血压升高和高密度脂蛋白胆固醇降低是危险因素,而红细胞增多症是罕见且可治疗的。大多数可用数据是观察性的,基于生化标志物,而不是更直接的心血管损伤测量。对这些观察到的变化的解释大多缺乏。心理压力和生活方式因素往往在急需的综合方法中被遗忘。据报道,血压升高和高密度脂蛋白胆固醇降低是危险因素,而红细胞增多症是罕见且可治疗的。大多数可用数据是观察性的,基于生化标志物,而不是更直接的心血管损伤测量。对这些观察到的变化的解释大多缺乏。心理压力和生活方式因素往往在急需的综合方法中被遗忘。

更新日期:2021-09-27
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