变性人的医疗保健:代谢结果和心血管风险。

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetologia Pub Date : 2024-11-01 Epub Date: 2024-07-03 DOI:10.1007/s00125-024-06212-6
Dorte Glintborg, Louise L Christensen, Marianne S Andersen
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引用次数: 0

摘要

变性身份往往与性别焦虑症和少数群体压力有关。性别确认激素治疗(GAHT)包括男性化或女性化治疗,在大多数情况下预计是终身性的。性别和性激素对顺性人的新陈代谢和心血管疾病有不同的影响,性腺功能减退症患者的性激素替代与较高的血管风险有关,尤其是在老年人中。我们采用叙事性综述的方法,介绍了有关 GAHT 期间代谢和心血管结果的证据,并就 GAHT 期间代谢和心血管风险指标的随访和监测提出了建议。现有数据显示,在变性人队列中,2 型糖尿病的风险并没有增加,但男性化 GAHT 会增加瘦体重,而女性化 GAHT 与较高的脂肪量和胰岛素抵抗有关。变性人群患心血管疾病的风险会增加,尤其是在女性化 GAHT 期间。男性化 GAHT 与更不利的血脂状况、更高的血细胞比容和更高的血压有关,而女性化 GAHT 与促凝血剂变化和更低的高密度脂蛋白胆固醇有关。出生时指定的男性性别、开始使用 GAHT 的较高年龄以及使用醋酸环丙孕酮是心血管疾病不良指标的单独风险因素。在性别确认护理期间,代谢和心血管疾病的治疗效果可能会有所改善,这是因为少数群体的压力减少、生活方式得到改善以及更密切的监测导致预防性药物(如他汀类药物)得到优化。GAHT 应根据个人风险因素(即药物、剂量和给药方式)进行个性化治疗;此外,医生需要讨论生活方式和预防性药物,以便在 GAHT 期间降低代谢和心血管疾病风险。随访计划必须针对通常的心血管风险指标,但也应考虑到生理年龄和性别可能会影响个体风险概况,包括心理健康、生活方式和 GAHT 期间的新型心血管风险指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Transgender healthcare: metabolic outcomes and cardiovascular risk.

Transgender healthcare: metabolic outcomes and cardiovascular risk.

Transgender identity is often associated with gender dysphoria and minority stress. Gender-affirming hormone treatment (GAHT) includes masculinising or feminising treatment and is expected to be lifelong in most cases. Sex and sex hormones have a differential effect on metabolism and CVD in cisgender people, and sex hormone replacement in hypogonadism is associated with higher vascular risk, especially in ageing individuals. Using narrative review methods, we present evidence regarding metabolic and cardiovascular outcomes during GAHT and propose recommendations for follow-up and monitoring of metabolic and cardiovascular risk markers during GAHT. Available data show no increased risk for type 2 diabetes in transgender cohorts, but masculinising GAHT increases lean body mass and feminising GAHT is associated with higher fat mass and insulin resistance. The risk of CVD is increased in transgender cohorts, especially during feminising GAHT. Masculinising GAHT is associated with a more adverse lipid profile, higher haematocrit and increased BP, while feminising GAHT is associated with pro-coagulant changes and lower HDL-cholesterol. Assigned male sex at birth, higher age at initiation of GAHT and use of cyproterone acetate are separate risk factors for adverse CVD markers. Metabolic and CVD outcomes may improve during gender-affirming care due to a reduction in minority stress, improved lifestyle and closer surveillance leading to optimised preventive medication (e.g. statins). GAHT should be individualised according to individual risk factors (i.e. drug, dose and form of administration); furthermore, doctors need to discuss lifestyle and preventive medications in order to modify metabolic and CVD risk during GAHT. Follow-up programmes must address the usual cardiovascular risk markers but should consider that biological age and sex may influence individual risk profiling including mental health, lifestyle and novel cardiovascular risk markers during GAHT.

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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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