Transseksüalizm tanılı karşı cins hormon replasman tedavisi alan bireylerin metabolik parametrelerinin retrospektif incelenmesi
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Transseksüalizm tanılı bireylerde cerrahi ve hormonal prosedürlerle karşı cinsiyet özellikleri geliştirilmesi temel prensiptir. Trans bireylerin hormon tedavisi endokrinologların çok önemli bir rol oynadığı multidisipliner bir yaklaşımı gerektirir. Hormon tedavisinin, kısa ve orta vadede kabul edilebilir derecede güvenli olduğunu, endişe duyulan etkilerin suprafizyolojik dozlarda ortaya çıktığını gösteren çalışmalar olmakla birlikte ; transseksüel bireylerin hormon tedavisinin sağlanmasında ve takibinde yeterli bilgi ve deneyimin olmaması sağlık hizmetlerinin önünde bir engeldir. Gereç ve Yöntem: 2010-2020 yılları arasında Ege Üniversitesi Hastanesi Endokrinoloji Bilim Dalı Polikliniğine başvurmuş ve transseksüalizm tanısı ile hormon replasman tedavisi başlanmış bireyler dahil edilmiştir. 326 dosya retrospektif olarak taranarak, 167 bireyin analizleri yapılmıştır. Bireylerin hormon tedavisine başlamadan önceki metabolik parametreleri ile hormon tedavisi sonrası 3-6.ay , 1. yıl ve 2.yıl takiplerindeki metabolik parametreleri karşılaştırılmıştır. Bulgular: Endokrinoloji kliniği başvurusu yapıp hormon tedavisi başlanan trans bireylerin %51'i takibe devam etmiştir. Bu bireylerin de %95 ini trans erkek bireylerin oluşturduğu görülmüştür. Trans erkeklerde hormonların metabolik parametreler üzerine etkisi incelenmiştir. Lipid parametreleri açısından zaman bağımlı olarak incelendiğinde, 2 yıllık takipte total kolesterol değeri artmıştır ancak bu artış istatistiki olarak anlamlı bulunmamıştır (p>0.05). Trigliseridde bazal değer ile her üç takipte saptanan değeri karşılaştırılmış ve 3-6.ay, 1.yıl , 2. yıl takiplerinde bazal değere göre anlamlı bir artış saptanmıştır (p<0.05). LDL artışı hormon öncesi ile 1. yıl ve hormon öncesi ile 2. yıl arasında anlamlı olarak bulunmuştur (p<0.05). HDL ise hormon öncesi ile 1.yıl, hormon öncesi ile 2.yıl arasında anlamlı olarak azalmıştır (p<0.05). Hormon kullanımının iki yıllık izlemde karaciğer fonksiyon testlerinden AST,ALT,GGT üzerinde istatistiki anlamlı değişime yol açmadığı görülmüştür. ALP üzerinde ise bazal değerler ile 1.yıl izlemi arasındaki değer arası fark anlamlı bulunmuştur. Kreatininin bazal değerler ile kıyaslanmasında 1.yıl hariç her üç takip zamanında da istatistiki olarak anlamlı olarak arttığı görülmüştür (p<0.05). Hemoglobin değerindeki artış hormon öncesi ile 3-6.ay, 1.yıl ve 2.yıl arasında anlamlı bulunmuştur (p<0.05). Sonuç: Trans bireylerde hormon kullanımı başta lipid paneli olmak üzere metabolik parametreler üzerinde etkili bulunmuştur. Hormon tedavisinin hemogram parametreleri ve metabolik parametreler üzerine olan etkisinin kardiyovasküler ve endokrinolojik komplikasyonlar ile ilişkisi açısından ileri çalışmalar gerekmektedir.
Background: It is the basic principle to develop opposite sex characteristics in transsexual individuals by surgical and hormonal procedures. Hormonal therapy for transgender individuals requires a multidisciplinary approach. Endocrinologists play a big part in this process. Lack of sufficient knowledge and experience in the practice and follow-up of hormonal therapy for transgender individuals is an obstacle for healthcare services. In this study, it was aimed to show whether hormonal therapy has an effect on metabolic parameters in transgender individuals. Mehtods: Outpatients who applied to the Ege University Faculty of Medicine Department of Endocrinology and Metabolic Diseases between 2010 and 2020 and were started on hormone replacement therapy due to transsexualism were included in this study. 167 individuals were analyzed by scanning 326 files retrospectively. The metabolic parameters of the individuals before starting hormone therapy were compared with the metabolic parameters in the 3-6th month, first year and second year after the initiation of hormone therapy. Results: 51% of transgender individuals who applied to the endocrinology clinic and started hormone therapy continued to follow up. It has been observed that 95% of these individuals are trans men. The effects of hormones on metabolic parameters in trans men have been examined. The alteration of lipid parameters was examined as time-dependent. During the 2-year follow-up, the total cholesterol value increased, but this increase was not statistically significant (p> 0.05). The value of triglyceride that before treatment and the values after treatment were compared. Accordingly, a significant increase was found in the 3-6th month, 1st year, and 2nd year compared to the basal value (p <0.05). LDL (low-density lipoprotein) values were found to be significantly increased between before hormone therapy and 1st year, and between before hormone therapy and 2nd year (p <0.05). HDL (high-density lipoprotein) values were found to be significantly decreased between before hormone therapy and 1st year, and between before hormone therapy and 2nd year (p <0.05). In addition, the liver function test was evaluated. AST (aspartate aminotransferase), ALT (alanine aminotransferase), and GGT (gamma-glutamyl transferase) values were not found to be statistically significant during the two-year follow-up of hormone therapy. ALP (alkaline phosphatase) was found to be increased significantly between before treatment and 1st-year follow-up (p <0.05). The creatinine levels in the 3rd-6th month, 1st year, and 2nd year were compared with the baseline values. Creatinine levels were found to be increased compared to the basal value all three times. This result was found to be statistically significant (p <0.05). In addition, the increase in hemoglobin value compared with baseline level and 3-6th months, 1st year, and 2nd-year levels were found to be statistically significant (p <0.05). Conclusion: Further studies are required to evaluate relationship between the effects of hormone therapy on metabolic parameters and complications of cardiovascular and endocrinological.
Background: It is the basic principle to develop opposite sex characteristics in transsexual individuals by surgical and hormonal procedures. Hormonal therapy for transgender individuals requires a multidisciplinary approach. Endocrinologists play a big part in this process. Lack of sufficient knowledge and experience in the practice and follow-up of hormonal therapy for transgender individuals is an obstacle for healthcare services. In this study, it was aimed to show whether hormonal therapy has an effect on metabolic parameters in transgender individuals. Mehtods: Outpatients who applied to the Ege University Faculty of Medicine Department of Endocrinology and Metabolic Diseases between 2010 and 2020 and were started on hormone replacement therapy due to transsexualism were included in this study. 167 individuals were analyzed by scanning 326 files retrospectively. The metabolic parameters of the individuals before starting hormone therapy were compared with the metabolic parameters in the 3-6th month, first year and second year after the initiation of hormone therapy. Results: 51% of transgender individuals who applied to the endocrinology clinic and started hormone therapy continued to follow up. It has been observed that 95% of these individuals are trans men. The effects of hormones on metabolic parameters in trans men have been examined. The alteration of lipid parameters was examined as time-dependent. During the 2-year follow-up, the total cholesterol value increased, but this increase was not statistically significant (p> 0.05). The value of triglyceride that before treatment and the values after treatment were compared. Accordingly, a significant increase was found in the 3-6th month, 1st year, and 2nd year compared to the basal value (p <0.05). LDL (low-density lipoprotein) values were found to be significantly increased between before hormone therapy and 1st year, and between before hormone therapy and 2nd year (p <0.05). HDL (high-density lipoprotein) values were found to be significantly decreased between before hormone therapy and 1st year, and between before hormone therapy and 2nd year (p <0.05). In addition, the liver function test was evaluated. AST (aspartate aminotransferase), ALT (alanine aminotransferase), and GGT (gamma-glutamyl transferase) values were not found to be statistically significant during the two-year follow-up of hormone therapy. ALP (alkaline phosphatase) was found to be increased significantly between before treatment and 1st-year follow-up (p <0.05). The creatinine levels in the 3rd-6th month, 1st year, and 2nd year were compared with the baseline values. Creatinine levels were found to be increased compared to the basal value all three times. This result was found to be statistically significant (p <0.05). In addition, the increase in hemoglobin value compared with baseline level and 3-6th months, 1st year, and 2nd-year levels were found to be statistically significant (p <0.05). Conclusion: Further studies are required to evaluate relationship between the effects of hormone therapy on metabolic parameters and complications of cardiovascular and endocrinological.
Açıklama
Anahtar Kelimeler
Transeksualizm, Trans Birey, Trans Erkek, Dislipidemi, Metabolik, Kardiyovasküler Hastalık, Transsexual, Transgender Person, Female to Male, Dyslipidemias, Metabolic, Cardiovascular Diseases
