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Metabolic profile differs between transgender adolescents, teens with PCOS despite testosterone levels
ORLANDO, Fla. — The profile of metabolic disease risk among adolescents transitioning from female to male and adolescents with polycystic ovary syndrome may not be similar despite elevated serum testosterone concentrations in both groups.
Natalie Nokoff, MD, a fellow in pediatric endocrinology at Children’s Hospital Colorado, and colleagues evaluated nine adolescents (mean age, 16.5 years) transitioning from female to male to determine the cardiometabolic effects of testosterone therapy; they also evaluated 25 adolescents (mean age, 16.4 years) with PCOS to compared the two groups.
Transitioning participants had a mean length of testosterone therapy of 358 days and a dose of 254 mg per month. Transitioning participants had significantly higher serum testosterone (399.1 ng/dL) compared with participants with PCOS (43 ng/dL; P < .0001).
Compared with participants with PCOS, transitioning participants had greater insulin sensitivy (P = .0005); lower fasting glucose (P = .002) and percent body fat (P = .001); lower levels of leptin (P = .03), aspartate aminotransferase (P = .008) and alanine aminotransferase (P = .001); and somewhat lower levels of sex hormone binding globulin (P = .06).
Both groups had similar serum lipid concentrations, triglycerides and serum estradiol.
“Our preliminary data suggest that despite significantly elevated serum testosterone concentrations, female-to-male adolescents on testosterone therapy may not have the same profile of metabolic disease risk as females with endogenous elevations of testosterone,” Nokoff told Endocrine Today. “We have very little information on the long-term health risks of hormone therapy in transgender individuals. We need long-term studies to better understand these risks and to improve counseling and informed consent for patients.” – by Amber Cox
Reference:
Nokoff NJ, et al. OR36-4. Presented at: The Endocrine Society Annual Meeting; April 1-4, 2017; Orlando, Fla.
Disclosures: Nokoff reports no relevant financial disclosures.
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There is very limited literature on transgender medicine in adults and especially in teens. I think this study opens the door as far as research in the area of transgender medicine.
This was a small study. There were only nine adolescents, and the study was a short. Having larger cohort studies and looking at the long-term effects of hormone therapy will be very important. Also, the study was done in Denver, which can be a homogenous population. Expanding the study and conducting more multi-center research across the country will be important, looking at larger sample sizes and more diverse populations.
As far as PCOS, we know that the condition is a pretty intricate diagnosis, involving both genetic and environmental factors. Intrauterine factors are being further evaluated as well. With PCOS it is not just the elevated testosterone level that ends up affecting insulin resistance and risk for prediabetes or type 2 diabetes. There are also multiple other factors and other hormones involved. So, it is perhaps not surprising that, compared with the participants in the PCOS group, the transitioning participants were more insulin sensitive and had lower fasting glucose and percent body fat because these are two different populations of patients. Insulin resistance and obesity comprise a big portion of patients with PCOS, but half the patients are found to have some degree of insulin resistance, regardless of their weight. So, it is not surprising that the transitioning patients were found to have a lower fasting glucose and lower liver enzymes than the PCOS group.