Iris Yaish, Guy Gindis, Yona Greenman, Yaffa Moshe, Mira Arbiv, Assaf Buch, Yael Sofer, Gabi Shefer, Karen Tordjman
{"title":"舌下雌二醇与联合口服雌二醇和醋酸环丙孕酮对未接受治疗的变性女性进行性别确认激素治疗相比没有明显优势:一项前瞻性试点研究的结果","authors":"Iris Yaish, Guy Gindis, Yona Greenman, Yaffa Moshe, Mira Arbiv, Assaf Buch, Yael Sofer, Gabi Shefer, Karen Tordjman","doi":"10.1089/trgh.2023.0022","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Chronic gender-affirming hormone therapy (GAHT) with sublingual estradiol (SLE) has not been studied. We aimed to compare GAHT with SLE only, to combined oral (CO) estradiol and cyproterone acetate, in treatment-naive trans women.</p><p><strong>Methods: </strong>Twenty-two trans women enrolled into either the CO arm or the SLE-only arm (0.5 mg four times daily) in this 6-month prospective study. Anthropometric and laboratory variables were collected at baseline and 3 and 6 months. At the study beginning and end, body composition was measured by dual-energy X-ray absorptiometry and bioelectrical impedance, and gender dysphoria, sexual desire, and function were assessed by validated questionnaires.</p><p><strong>Results: </strong>Subjects in the SLE were older, 26.3±5.8 years versus 20.1±2.3 years, <i>p</i>=0.006. All anthropometric, body composition, and laboratory variables were identical at baseline. Although dysphoria appeared greater, and sexual function lower at baseline in the CO group, this canceled out after age adjustment. Both treatments induced similar biochemical and hormonal changes. Creatinine, hemoglobin and cholesterol decreased significantly, while testosterone was suppressed to the same level in both groups: 3.22 [1.47-5.0] nmol/L in the SLE group and 2.41 [0.55-8.5] nmol/L in the CO, <i>p</i>=0.65. Significant changes in body composition toward a more feminine body were noted in both groups. Dysphoria did not significantly improve in either group, while sexual desire and function decreased at six months in both, <i>p</i><0.001.</p><p><strong>Conclusions: </strong>Both treatments achieved similar clinical changes. At this stage, SLE, which repeatedly induces alarming excursions of serum estradiol throughout the day, appears to offer no advantage over the CO approach.</p>","PeriodicalId":37265,"journal":{"name":"Transgender Health","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10732161/pdf/","citationCount":"0","resultStr":"{\"title\":\"Sublingual Estradiol Offers No Apparent Advantage Over Combined Oral Estradiol and Cyproterone Acetate for Gender-Affirming Hormone Therapy of Treatment-Naive Trans Women: Results of a Prospective Pilot Study.\",\"authors\":\"Iris Yaish, Guy Gindis, Yona Greenman, Yaffa Moshe, Mira Arbiv, Assaf Buch, Yael Sofer, Gabi Shefer, Karen Tordjman\",\"doi\":\"10.1089/trgh.2023.0022\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Chronic gender-affirming hormone therapy (GAHT) with sublingual estradiol (SLE) has not been studied. We aimed to compare GAHT with SLE only, to combined oral (CO) estradiol and cyproterone acetate, in treatment-naive trans women.</p><p><strong>Methods: </strong>Twenty-two trans women enrolled into either the CO arm or the SLE-only arm (0.5 mg four times daily) in this 6-month prospective study. Anthropometric and laboratory variables were collected at baseline and 3 and 6 months. At the study beginning and end, body composition was measured by dual-energy X-ray absorptiometry and bioelectrical impedance, and gender dysphoria, sexual desire, and function were assessed by validated questionnaires.</p><p><strong>Results: </strong>Subjects in the SLE were older, 26.3±5.8 years versus 20.1±2.3 years, <i>p</i>=0.006. All anthropometric, body composition, and laboratory variables were identical at baseline. Although dysphoria appeared greater, and sexual function lower at baseline in the CO group, this canceled out after age adjustment. Both treatments induced similar biochemical and hormonal changes. Creatinine, hemoglobin and cholesterol decreased significantly, while testosterone was suppressed to the same level in both groups: 3.22 [1.47-5.0] nmol/L in the SLE group and 2.41 [0.55-8.5] nmol/L in the CO, <i>p</i>=0.65. Significant changes in body composition toward a more feminine body were noted in both groups. Dysphoria did not significantly improve in either group, while sexual desire and function decreased at six months in both, <i>p</i><0.001.</p><p><strong>Conclusions: </strong>Both treatments achieved similar clinical changes. At this stage, SLE, which repeatedly induces alarming excursions of serum estradiol throughout the day, appears to offer no advantage over the CO approach.</p>\",\"PeriodicalId\":37265,\"journal\":{\"name\":\"Transgender Health\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2023-12-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10732161/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transgender Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1089/trgh.2023.0022\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"Social Sciences\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transgender Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1089/trgh.2023.0022","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"Social Sciences","Score":null,"Total":0}
引用次数: 0
摘要
目的:目前尚未对舌下含服雌二醇(SLE)的慢性性别确认激素疗法(GAHT)进行研究。我们旨在比较仅使用 SLE 的 GAHT 与联合口服(CO)雌二醇和醋酸环丙孕酮对未经治疗的变性女性的治疗效果:在这项为期 6 个月的前瞻性研究中,22 名变性女性加入了 CO 组或仅 SLE 组(0.5 毫克,每日四次)。在基线、3 个月和 6 个月时收集人体测量和实验室变量。在研究开始和结束时,通过双能 X 射线吸收测量法和生物电阻抗测量身体成分,并通过有效问卷评估性别焦虑症、性欲和性功能:结果:系统性红斑狼疮患者的年龄更大,为 26.3±5.8 岁(P=0.006),而系统性红斑狼疮患者的年龄为 20.1±2.3岁(P=0.006)。基线时的所有人体测量、身体成分和实验室变量均相同。虽然 CO 组基线时的焦虑症更严重,性功能更低,但经过年龄调整后,焦虑症和性功能低的情况相抵消。两种治疗方法引起的生化和激素变化相似。肌酐、血红蛋白和胆固醇显著下降,而睾酮在两组中均被抑制至相同水平:系统性红斑狼疮组为 3.22 [1.47-5.0] nmol/L,而慢性阻塞性肺病组为 2.41 [0.55-8.5] nmol/L,P=0.65。两组患者的身体成分都发生了显著变化,变得更加女性化。两组患者的性焦虑都没有明显改善,而两组患者的性欲和性功能在六个月后都有所下降,P=0.65:两种治疗方法都取得了类似的临床变化。在现阶段,系统性红斑狼疮会在一天中反复引起血清雌二醇的惊人偏移,与 CO 方法相比似乎没有优势。
Sublingual Estradiol Offers No Apparent Advantage Over Combined Oral Estradiol and Cyproterone Acetate for Gender-Affirming Hormone Therapy of Treatment-Naive Trans Women: Results of a Prospective Pilot Study.
Purpose: Chronic gender-affirming hormone therapy (GAHT) with sublingual estradiol (SLE) has not been studied. We aimed to compare GAHT with SLE only, to combined oral (CO) estradiol and cyproterone acetate, in treatment-naive trans women.
Methods: Twenty-two trans women enrolled into either the CO arm or the SLE-only arm (0.5 mg four times daily) in this 6-month prospective study. Anthropometric and laboratory variables were collected at baseline and 3 and 6 months. At the study beginning and end, body composition was measured by dual-energy X-ray absorptiometry and bioelectrical impedance, and gender dysphoria, sexual desire, and function were assessed by validated questionnaires.
Results: Subjects in the SLE were older, 26.3±5.8 years versus 20.1±2.3 years, p=0.006. All anthropometric, body composition, and laboratory variables were identical at baseline. Although dysphoria appeared greater, and sexual function lower at baseline in the CO group, this canceled out after age adjustment. Both treatments induced similar biochemical and hormonal changes. Creatinine, hemoglobin and cholesterol decreased significantly, while testosterone was suppressed to the same level in both groups: 3.22 [1.47-5.0] nmol/L in the SLE group and 2.41 [0.55-8.5] nmol/L in the CO, p=0.65. Significant changes in body composition toward a more feminine body were noted in both groups. Dysphoria did not significantly improve in either group, while sexual desire and function decreased at six months in both, p<0.001.
Conclusions: Both treatments achieved similar clinical changes. At this stage, SLE, which repeatedly induces alarming excursions of serum estradiol throughout the day, appears to offer no advantage over the CO approach.