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The implications of hormone treatment for cancer risk, screening and treatment in transgender individuals 激素治疗对变性人患癌风险、筛查和治疗的影响。
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 DOI: 10.1016/j.beem.2024.101909

There is evidence that gender-affirming hormone treatment (GAHT) for transgender individuals modulates their risk for specific malignancies including breast and prostate cancer, and meningiomas. However, there is insufficient data to make precise risk estimates accounting for age and inherited cancer risk. As such, screening recommendations remain broad. Even less evidence exists for best practice in the management of active or historical cancers in the transgender population. Guidance is therefore mainly extrapolated from cisgender populations but with considerations of the significant benefits of GAHT in the face of any hormonal risk. Clinical experience, the multidisciplinary team and shared decision making with the patient are vital in providing person-centred care, while further research is acquired.

有证据表明,变性人接受性别确认激素治疗(GAHT)会降低他们罹患特定恶性肿瘤(包括乳腺癌、前列腺癌和脑膜瘤)的风险。然而,目前还没有足够的数据对年龄和遗传性癌症风险做出精确的风险估计。因此,筛查建议仍然很宽泛。关于变性人中活动性癌症或历史性癌症的最佳治疗方法的证据就更少了。因此,指导意见主要是从双性恋人群中推断出来的,但考虑到在面对任何激素风险时,GAHT 的显著益处。在开展进一步研究的同时,临床经验、多学科团队以及与患者共同决策对于提供以人为本的护理至关重要。
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引用次数: 0
Testosterone-induced erythrocytosis in transgender males: Challenges arising from an increasing prevalence of metabolic syndrome and wider therapeutic indications for prescribing SGLT2 inhibitor drugs 变性男性睾酮诱发的红细胞增多症:代谢综合征发病率上升带来的挑战以及 SGLT2 抑制剂药物处方治疗适应症的扩大。
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 DOI: 10.1016/j.beem.2024.101930
Azmi Mohammed (Endocrinologist) , Yaasir H. Mamoojee (Endocrinologist) , Richard Quinton (Endocrinologist)
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引用次数: 0
Gender-affirming hormone treatment modalities for transfemale & non-binary transfeminine individuals: A UK perspective 针对变性女性和非二元变性女性的性别确认激素治疗模式:英国视角。
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 DOI: 10.1016/j.beem.2024.101921
Rebecca C. Sagar (Academic Clinical Lecturer and Honorary Specialist Registrar in Endocrinology) , Victoria Millson-Brown (Consultant Endocrinologist)

Gender incongruence and the number of people seeking gender affirming hormone treatment has dramatically risen in the last two decades. In the UK, transgender women and non-binary transfeminine individuals are typically treated with simultaneous suppression of endogenous testosterone production through anti-androgens and exogenous oestradiol replacement. Oestrogen replacement comes in different forms and is primarily given as transdermal (gel or patch) or oral preparations in the UK. Decisions around preparation choice are based on a combination of individual preference and/or mitigating the chance of complications based on individual risk profiles. Time frames to achieve female physical changes are largely predictable and managing expectations of individuals prior to commencing treatment is highly important. Common complications include venous thromboembolism, liver dysfunction and effects on fertility, thus individuals should be thoroughly counselled prior to commencing treatment. This article provides an overview of the management and considerations of gender-affirming hormone treatment in transgender women and non-binary transfeminine individuals.

在过去二十年里,性别不协调和寻求性别肯定激素治疗的人数急剧上升。在英国,变性女性和非二元跨性别者通常会同时接受抗雄激素抑制内源性睾酮分泌和外源性雌二醇替代治疗。雌激素替代有不同的形式,在英国主要是透皮(凝胶或贴片)或口服制剂。有关制剂选择的决定是基于个人偏好和/或根据个人风险概况降低并发症几率的综合考虑。实现女性生理变化的时间框架在很大程度上是可以预测的,因此在开始治疗前管理好个人的期望值非常重要。常见的并发症包括静脉血栓栓塞、肝功能障碍和对生育能力的影响,因此在开始治疗前应向患者提供全面的咨询。本文概述了变性女性和非二元跨性别者在接受性别确认激素治疗时的管理和注意事项。
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引用次数: 0
Metabolic and cardiovascular risks of hormone treatment for transgender individuals 变性人接受激素治疗的代谢和心血管风险。
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 DOI: 10.1016/j.beem.2024.101907

Identifying metabolic and cardiovascular risks of gender-affirming hormone therapy (GAHT) is challenging due to other confounding variables that affect patient outcomes and the diversity of treatment regimes. Masculinising hormone therapy produces atherogenic lipid profiles, while effects on other metabolic parameters are not consistent. There is insufficient evidence to conclude if cardiovascular disease risk among transmen is increased. The effects of feminising hormone therapy on metabolic parameters do not demonstrate a consistent pattern in the available literature. However, the risk of venous thromboembolism is greater in transwomen than in cis-gender men and women with a possible increase in cardiovascular disease risk. It is recommended to discuss the potential effects of GAHT on cardiovascular health and encourage patients seeking GAHT to adopt a healthy lifestyle. Performing baseline and periodic assessments of cardiovascular risk factors would enable early identification and interventions. In high-risk individuals, the cardiovascular effects of hormonal regimes might impact the treatment decision.

由于影响患者预后的其他混杂变量以及治疗方案的多样性,确定性别确认激素疗法(GAHT)的代谢和心血管风险具有挑战性。男性化激素疗法会产生致动脉粥样硬化的血脂谱,而对其他代谢参数的影响并不一致。目前还没有足够的证据来断定变性人患心血管疾病的风险是否会增加。在现有文献中,女性化激素疗法对新陈代谢参数的影响并未显示出一致的模式。不过,变性女性罹患静脉血栓栓塞症的风险高于同性别的男性和女性,可能会增加心血管疾病风险。建议讨论变性手术对心血管健康的潜在影响,并鼓励寻求变性手术的患者采取健康的生活方式。对心血管风险因素进行基线评估和定期评估将有助于早期识别和干预。对于高危人群,激素疗法对心血管的影响可能会影响治疗决策。
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引用次数: 0
Clinical considerations and endocrinological implications in the detransition process 脱胎换骨过程中的临床考虑因素和内分泌学影响。
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 DOI: 10.1016/j.beem.2024.101932
Laura Charlton (Clinical Lead/Consultant Clinical Psychologist) , Ruth Bond (GP with special interest in Gender Dysphoria)

Detransition, the process of reverting to one’s gender assigned at birth after a period of transition, or moving away from the original transition goal, presents unique challenges in healthcare. This paper introduces the clinical issue and provides a comprehensive overview of the ethical, psychological, legal, surgical, and endocrinological considerations involved in supporting individuals who choose to detransition. It emphasises the importance of patient-centred care, informed consent, and the need for expanded research to address the specific needs of this population. The paper highlights the complexities of endocrine management, surgical reversals, and the necessity for comprehensive support systems. Key psychotherapeutic interventions, including trauma-focused Cognitive Behavioural Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and third-wave approaches like Compassion-Focused Therapy (CFT), are recommended to manage associated trauma and shame. By adopting a holistic approach, healthcare providers can better assist individuals navigating the complexities of detransition.

变性是指在过渡期后恢复到出生时的性别,或偏离最初的变性目标,这一过程给医疗保健带来了独特的挑战。本文介绍了这一临床问题,并全面概述了在为选择变性的个人提供支持时所涉及的伦理、心理、法律、外科和内分泌学方面的考虑因素。它强调了以患者为中心的护理、知情同意的重要性,以及扩大研究以满足这一人群特殊需求的必要性。论文强调了内分泌管理、手术逆转的复杂性以及综合支持系统的必要性。建议采取关键的心理治疗干预措施,包括以创伤为重点的认知行为疗法(CBT)、眼动脱敏和再处理疗法(EMDR)以及第三波疗法(如以同情为重点的疗法(CFT)),以控制相关的创伤和羞耻感。通过采用综合方法,医疗服务提供者可以更好地帮助个人应对复杂的脱离社会问题。
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引用次数: 0
Testosterone and other treatments for transgender males and non-binary trans masculine individuals 针对变性男性和非二元变性男性的睾丸激素和其他治疗方法。
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 DOI: 10.1016/j.beem.2024.101908

Testosterone therapy is the main hormonal treatment offered in transmen to alleviate somatic gender dysphoria. Testosterone can be administered via topical or injectable preparations to achieve physical changes resulting in masculinisation and improve quality of life for the treated individuals. The aim of our paper is to outline methods for testosterone replacement, their impact on main body systems of transmen, potential associated health risks and long term follow up. Androgen use in transgender medicine is safe with appropriate endocrine guidance and monitoring. Studies with longer follow-up period, including those who may prefer low dose testosterone, interested in pregnancy or older people may further improve the management of female-to-male transgender persons.

睾酮疗法是为变性人提供的主要荷尔蒙疗法,以缓解躯体性别障碍。睾酮可通过外用或注射制剂来实现身体变化,从而实现男性化,并改善接受治疗者的生活质量。本文旨在概述睾酮替代方法、其对变性人主要身体系统的影响、潜在的相关健康风险和长期随访。在适当的内分泌指导和监测下,变性人使用雄激素是安全的。进行更长期的随访研究,包括那些可能偏好小剂量睾酮、对怀孕感兴趣或年龄较大的人,可进一步改善对女男变性者的管理。
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引用次数: 0
Transgender 变性人
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-01 DOI: 10.1016/j.beem.2024.101933
Peter Hammond (Consultant Endocrinologist and Endocrinology Lead for the Leeds Regional Gender Identity Service)
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引用次数: 0
Best practice and research, clinical endocrinology and metabolism preface to the special issue: Diagnosis and treatment of acromegaly acromegaly, a paradigmatic disease second part: Treatment 最佳实践与研究,临床内分泌学与新陈代谢》特刊序言:肢端肥大症的诊断和治疗 肢端肥大症,一种典型疾病 第二部分:治疗。
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101912
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引用次数: 0
Surgical outcomes in patients with acromegaly: Microscopic vs. endoscopic transsphenoidal surgery 肢端肥大症患者的手术效果:显微镜与内窥镜经蝶手术
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101879

Transsphenoidal resection of growth hormone-secreting pituitary neuroendocrine tumors remains the first-line treatment for acromegaly. This can be performed through microsurgery or endoscopic surgery. For the past decades, endoscopic surgery has become the preferred technique in an increasing number of centers worldwide. However, whether it offers superior clinical outcomes has yet to be determined. In this paper, we performed a narrative review of the literature comparing both techniques in the treatment of acromegaly. We critically assessed available comparative studies from an objective perspective to determine their suitability for defining superiority of either technique. Available evidence displays substantial methodological variations and reports conflicting findings. Although endoscopic surgery provides a wider exposure and enhanced visibility of the surgical field, this does not consistently translate into better clinical outcomes, as most tumors are equally accessible through both techniques. Postoperative outcomes such as remission and complication rates are similar between both techniques. The management of acromegaly should be performed by experienced pituitary neurosurgeons, regardless of the approach. The involvement of a multidisciplinary team in a dedicated pituitary center is critical to ensure optimal outcomes.

经蝶窦切除分泌生长激素的垂体神经内分泌肿瘤仍然是治疗肢端肥大症的一线疗法。这种手术可以通过显微外科手术或内窥镜手术进行。过去几十年来,内窥镜手术已成为全球越来越多中心的首选技术。然而,内窥镜手术是否能提供更优越的临床疗效仍有待确定。在本文中,我们对这两种治疗肢端肥大症的技术进行了文献综述。我们从客观的角度对现有的比较研究进行了批判性评估,以确定这些研究是否适合定义两种技术的优越性。现有证据在方法上存在很大差异,报告的结果也相互矛盾。虽然内窥镜手术能使手术视野更开阔,能见度更高,但这并不能持续转化为更好的临床结果,因为大多数肿瘤在两种技术下都能被同样地触及。两种技术的术后效果(如缓解率和并发症发生率)相似。无论采用哪种方法,都应由经验丰富的垂体神经外科医生进行肢端肥大症的治疗。在专门的垂体中心,多学科团队的参与对于确保最佳疗效至关重要。
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引用次数: 0
Growth hormone receptor antagonist pegvisomant and its role in the medical therapy of growth hormone excess 生长激素受体拮抗剂 pegvisomant 及其在生长激素过量医疗中的作用。
IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-01 DOI: 10.1016/j.beem.2024.101910

Pegvisomant is a growth-hormone (GH) receptor antagonist that prevents the formation of the active heterotrimer of the dimerised GH receptor and the GH molecule necessary for downstream signal transduction. Over the past 20 years, it has become a key therapeutic option for physicians treating syndromes of GH/IGF-1 excess. Sufficient longitudinal follow-up data suggest that it can be deemed both safe and effective. It is the drug with the greatest potential for achieving an amelioration of the biochemical effects of GH excess with a corresponding normalisation of IGF-1 levels; however, insufficient dose titration has lessened real-world therapeutic outcomes. Theoretical concerns about stimulating tumour growth have been resolved as this has not been observed, while derangement of liver enzymes and local skin-related adverse reactions may occur in a minority of the patients. It may be a particularly impactful medication for the treatment of children, young people, and those with inherited disorders of GH excess, where other treatment modalities often fail. Combination therapy of pegvisomant with first- and second-generation somatostatin receptor ligands or with dopamine agonists remains an ongoing area of interest and research. High cost remains a barrier to the use of pegvisomant in many settings.

培维索孟是一种生长激素(GH)受体拮抗剂,能阻止二聚化的 GH 受体与下游信号转导所需的 GH 分子形成活性异三聚体。在过去的 20 年中,它已成为医生治疗 GH/IGF-1 过多综合征的主要治疗选择。充分的纵向跟踪数据表明,它既安全又有效。它是最有可能改善 GH 过多的生化效应并相应地使 IGF-1 水平恢复正常的药物;然而,剂量滴定不足降低了实际治疗效果。理论上对刺激肿瘤生长的担忧已经消除,因为尚未观察到这种情况,但少数患者可能会出现肝酶紊乱和局部皮肤相关不良反应。对于治疗儿童、青少年和患有遗传性 GH 过多症的患者来说,它可能是一种特别有影响力的药物,因为其他治疗方法往往无法奏效。培维索孟与第一代和第二代体生长抑素受体配体或多巴胺激动剂的联合治疗仍是一个值得关注和研究的领域。在许多情况下,高昂的费用仍然是使用培高索曼的障碍。
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Best practice & research. Clinical endocrinology & metabolism
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