Hormone treatment for transgender youth appears safe

Last Updated: 2017-11-10

By Reuters Staff

NEW YORK (Reuters Health) - Gender-affirming hormone treatment for young people with gender dysphoria appears safe, according to a two-year follow-up study.

"Although the impact of hormones on some historically concerning physiologic parameters, including lipids, potassium, hemoglobin and prolactin, were statistically significant, clinical significance was not observed," Dr. Johanna Olson-Kennedy of Children's Hospital Los Angeles and colleagues write in their report, published online October 19 in the Journal of Adolescent Health.

Clinicians and parents are concerned about the safety of cross-gender hormone treatment for adolescents with gender dysphoria, Dr. Olson-Kennedy and her team note, and little data is available on the effects of the treatment in adolescents. They enrolled 101 young people (ages 12 to 23) who presented for treatment at their hospital, and were able to follow up two years later with 59 of them.

The researchers use the term "transfeminine" to refer to people "assigned male at birth who identify somewhere along the feminine spectrum" and the term "transmasculine" to refer to people "assigned female at birth who identify somewhere along the masculine spectrum."

Transfeminine young people had differences in high-density lipoprotein (HDL), aspartate aminotransferase, potassium, prolactin and hemoglobin at follow-up, the researchers found, although changes were as expected and levels were within normal range. Blood pressure and glucose also did not change.

For transmasculine youth, there were "mildly" clinically significant changes in blood pressure and HDL, and statistically but not clinically significant changes in triglycerides, aspartate aminotransferase, ALT, potassium, and hemoglobin.

"This study was limited by the variability in the adherence rates to medication, a problem common to both adolescents and those undergoing care for gender dysphoria," Dr. Olson-Kennedy and her colleagues note. "Barriers to access to medication, medical provider follow-up visits, and the natural tendency for youth to geographically relocate pose challenges to collecting data among this cohort."

While current guidelines recommend transgender patients undergo testing as often as every three months in the first year of treatment, based on the new findings, this may not be necessary, according to Dr. Olson-Kennedy and her team.

"Specifically, monitoring complete blood counts and chemistries including LFTs (liver function tests) are unnecessary except perhaps in transwomen who plan to go on spironolactone, in which case baseline potassium and creatinine levels would be reasonable," they write. Blood pressure rises in transmasculine patients should be followed, and those who develop hypertension should be treated, they add.

They conclude: "These data indicate that gender-affirming hormone therapy is safe over a time period of approximately two years. Future studies and follow-up information that includes longitudinal results are necessary."

Dr. Olson-Kennedy was not available for an interview by press time.

SOURCE: http://bit.ly/2iJJX8X

J Adolesc Health 2017.