Gender-affirming hormone therapy may increase serum creatinine among transgender men
Findings of this review suggest that gender-affirming hormone therapy may increase serum creatinine among transgender men but has the opposite effect among transgender women.
“It is important to understand how gender-affirming hormone therapy impacts kidney physiology and how it changes values of common laboratory tests so that patients are properly assessed and not mislabeled with health or disease with regard to kidney function,” David Collister, MD, PhD, from department of medicine at the University of Alberta in Canada, said in the press release.
In a systematic review and meta-analysis, researchers aimed to determine the change in kidney biomarkers, such as serum creatinine and GFR, in adult transgender individuals starting gender-affirming hormone therapy.
Researchers identified 4,758 randomized controlled trials, observational studies and case series on PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov that focused on measuring this change. All studies were independently screened. Researchers conducted a random effects meta-analysis to evaluate the change in outcomes during follow-up at 3, 6 and 12 months.
A total of 26 studies were included in the final analysis, nine of which recruited 488 transgender men and 593 women. By the 12-month follow-up, researchers identified a 0.15 mg/dL increase in serum creatinine among 370 transgender men. However, there was a — 0.05mg/dL decrease in serum creatine among 361 transgender women at the same follow-up.
Researchers observed heterogeneity in study design, population, gender-affirming hormone therapy routes and dosing. Of the studies examined, none reported the effect of gender-affirming hormone therapy on albuminuria, proteinuria, cystatin C or measured GFR.
In an accompanying editorial, Dinushika Mohottige, MD, MPH, from Duke University and Delphine S. Tuot, MD, from the University of California, wrote that the review by Collister and colleagues lacks “information regarding creatinine assay standardization and calibration across studies” and “individuals who identify as non-binary or otherwise gender-diverse, who may micro-dose or use varied formulations of gender-affirming hormone therapy [GAHT].” Similarly, all participants had normal kidney function at baseline.
“This analysis raises several important questions that should be the focus of subsequent investigations, most notably the mechanism through which GAHT is associated with changes in serum creatinine and whether GAHT independently affects kidney function,” Mohottige and Tuot wrote. They added, “Further studies are also needed to explore the association between sex hormones on kidney function and cardiovascular risks, particularly among individuals with [chronic kidney disease] CKD, for whom age, etiology of kidney disease (ie, nephrotic syndrome affecting sex hormone binding protein levels), severity of kidney disease and degree of proteinuria may modify these effects.”
References:
Does gender-affirming hormone therapy affect markers of kidney health? https://www.newswise.com/articles/does-gender-affirming-hormone-therapy-affect-markers-of-kidney-health?sc=dwhr&xy=10007438. Published Aug. 11, 2022. Accessed Aug. 18, 2022.
Advancing Kidney Health Equity. https://cjasn.asnjournals.org/content/early/2022/08/15/CJN.08280722. Published Aug. 15, 2022. Accessed Aug. 18, 2022.
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