Changes in Blood Lipids Following Initiation of Gender Affirming Hormone Therapy: A Systematic Review and Meta-Analysis

IF 4.2 Q1 ENDOCRINOLOGY & METABOLISM Journal of Clinical and Translational Endocrinology Pub Date : 2024-04-30 DOI:10.1016/j.jcte.2024.100349

Bennett Gosiker , Jude Moutchia , Nghiem Nguyen , Darios Getahun , Michael Goodman

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Abstract

Aim

The aim of this study was to conduct a systematic review and meta-analysis of changes in low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol, and triglycerides following initiation of feminizing or masculinizing gender affirming hormone therapy (GAHT).

Methods

A search of Ovid MEDLINE, Embase, Web of Science, SCOPUS, and CINAHL databases identified potentially relevant articles published from 1990 through 2024. Both observational and randomized trials of adults receiving feminizing or masculinizing GAHT with baseline and follow-up measures were included. Articles were reviewed for eligibility using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. The risk of bias in each study was quantified using the NHLBI Study Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group. Random effects models were used to compute the before-and-after meta-differences in mean values for each parameter along with the I² statistic to assess heterogeneity of results.

Results

Thirty-five studies met the criteria for inclusion in the meta-analysis. Masculinizing GAHT was associated with significant changes in serum lipids from baseline up through the 60-month timepoint with meta-difference of means (95% CI) estimates of 26.2mg/dL (23.3,29.0) for LDL-C, 26.1mg/dL (22.8,29.4) for total cholesterol, 30.7mg/dL (6.9,54.6) for triglycerides and –9.4mg/dL (–12.1, –6.7) for HDL-C. Studies evaluating the effects of feminizing GAHT on balance demonstrated no notable changes in HDL-C or triglycerides while the results for LDL-C and total cholesterol were inconsistent. Heterogeneity of results ranged from minimal (I² = 0%) to substantial (I² = 90%).

Conclusions

While the results for transfeminine individuals on GAHT appear somewhat reassuring, transmasculine patients receiving testosterone may benefit from closer monitoring of lipid profiles.

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启动性别平权激素疗法后血脂的变化：系统回顾与元分析

目的本研究旨在对开始接受女性化或男性化性别肯定激素疗法（GAHT）后低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、总胆固醇和甘油三酯的变化进行系统回顾和荟萃分析。纳入了对接受女性化或男性化GAHT治疗的成人进行基线和随访测量的观察性和随机试验。根据《系统综述和元分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-analyses，PRISMA）2020 指南对文章进行了资格审查。采用 NHLBI《无对照组前后（前-后）研究质量评估工具》对每项研究的偏倚风险进行量化。随机效应模型用于计算各参数平均值的前后元差异，I2 统计量用于评估结果的异质性。男性化 GAHT 与血清脂质从基线到 60 个月时间点的显著变化有关，平均值的元差异（95% CI）估计值为：低密度脂蛋白胆固醇 26.2 毫克/分升（23.3,29.0），总胆固醇 26.1 毫克/分升（22.8,29.4），甘油三酯 30.7 毫克/分升（6.9,54.6），高密度脂蛋白胆固醇-9.4 毫克/分升（-12.1,-6.7）。评估女性化 GAHT 对平衡的影响的研究表明，高密度脂蛋白胆固醇或甘油三酯没有明显变化，而低密度脂蛋白胆固醇和总胆固醇的结果则不一致。结果的异质性从最小（I2 = 0%）到最大（I2 = 90%）不等。结论虽然对使用 GAHT 的女性化患者的研究结果令人欣慰，但接受睾酮治疗的男性化患者可能会受益于对血脂谱的更密切监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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