Sex reassignment surgery may protect metabolic health of transgender women

Transgender women who undergo sex reassignment surgery and hormone therapy may be less likely to develop metabolic disease than those who receive hormone therapy alone. This is according to new research recently presented at Cardiovascular, Renal and Metabolic Diseases: Physiology and Gender - a conference of the American Physiological Society, held in Annapolis, MD.

Sex reassignment surgery combined with female hormone therapy may protect the metabolic health of transgender women, researchers suggest.

Previous research has suggested that transgender women are at greater risk for cardiovascular disease and type 2 diabetes, compared with men and women among the general population.

Some studies have put this increased risk down to female hormone therapy; therapy with the female hormoneestrogen, for example, has been linked to high blood pressure and increased risk of stroke and heart attack.

For this latest study, lead author Michael Nelson, PhD, of the Cedars-Sinai Medical Center in Los Angeles, CA, and colleagues set out to determine whether this metabolic risk varied depending on the type of therapy used make the male-to-female transition.

The team enrolled 12 transgender women to their study, four of whom were receiving female hormone therapy and eight of whom received a combination of female hormone therapy and bilateral orchiectomy - in which both testicles are surgically removed.

The researchers measured the insulin resistance and the accumulation of fat in the liver of each participant. They explain that insulin resistance is a key sign of poor metabolic health, and build-up of fat in the liver can cause nonalcoholic fatty liver disease - which studies have suggested can increase heart disease risk.

Bilateral orchiectomy may benefit metabolic health

Compared with transgender women who received female hormone therapy alone, those who received both female hormone therapy and bilateral orchiectomy were found to have better metabolic health.

Specifically, the team found that transgender women only receiving hormone therapy had greater insulin resistance and greater accumulation of fat in the liver than those who received both surgery and female hormone therapy.

Transgender women who had the highest levels of testosterone were found to have the poorest metabolic health, according to the researchers.

In addition, the team found that the amount of fat build-up in the liver was linked to the level of insulin resistance; whether the two are associated is an ongoing subject of debate in the medical world.

Overall, the researchers say their findings indicate transgender women who undergo bilateral orchiectomy may be protected against insulin resistance and fat build-up in the liver, while the two conditions are more likely to develop among those who receive hormone therapy alone.

Earlier this year, Medical News Today reported on a study that found transgender children do not have a hormone imbalance. - udy published in the Journal of Adolescent Health has revealed that the hormone levels of transgender youth are consistent with the gender they were assigned at birth.


A transgender symbol.

The term transgender is typically used to describe individuals whose gender self-identification does not match their birth-assigned gender.

"We've now put to rest the residual belief that transgender experience is a result of a hormone imbalance," says study author Dr. Johanna Olson of Children's Hospital Los Angeles (CHLA). "It's not."

The study conducted by Dr. Olson and colleagues is concerned with assessing the safety and effectiveness of treatments to help transgender patients bring their bodies closer in alignment to their gender identity.

Children who have reached puberty can be treated with gonadotrophin-releasing hormone (GnRH) analogs - synthetic hormones that suppress those produced by the body during puberty in order to delay physical changes to the body.

Such treatment is sought following the development of gender dysphoria - a sense of distress and anxiety that can occur when an individual feels dissonance between their gender identity and the sex they were assigned at birth. More and more young people are seeking treatment for this condition every year.

"Although transgender youth are known to be at high risk for depression, anxiety, and suicidality, there are no data available describing the physical and psychosocial characteristics of transgender adolescents seeking sex reassignment in the United States," the authors of the study write.

To amend this, the researchers have enrolled 101 transgender participants aged 12-24 years old for their prospective study. Of these, 51.5% were assigned "male" at birth and identify as transfeminine and 48.5% were assigned "female" at birth and identify as transmasculine.

After measuring a number of physiological parameters, the researchers discovered that the participants' hormone levels were in line with the normal ranges of the same assigned sex nontransgender youth population. Transmasculine participants had the same average hormone ranges as cisgender females and transfeminine participants had the same as cisgender males.

The researchers noted that many of the participants were overweight or obese, leading them to hypothesize that transgender individuals might use increased body fat to hide undesirable physical features.

Transgender youth aware of gender identity at early age

On average, the participants identified a discrepancy with their assigned gender at the age of 8. They did not tell their families until reaching, on average, the age of 17 years.

Alongside this, the researchers found that 35% of the participants reported symptoms of depression and that more than half had thoughts about suicide - significantly higher than the prevalence among general youth.

"Considering that transgender youth in this sample did not disclose their authentic gender to their families until 10 years after discovery on average, it might not be surprising that many are using maladaptive coping mechanisms to manage such a profound undisclosed element of their core selves," the authors write.

The prevalence of these mental health problems among transgender youth indicates that timely and appropriate intervention could be hugely beneficial to this group.

Having now established the baseline characteristics of the transgender participants, the researchers will continue to assess them over time, tracking the safety and efficacy of any medical interventions they receive as well as their impact on quality of life.

"My goal is to move kids who are having a gender-atypical experience from survive to thrive," Dr. Olson states. "With this study we hope to identify the best way to accomplish that."

The researchers will continue to publish follow-up data as they collect it, and they recommend that other medical centers providing care to transgender should consider collecting information and publishing their experiences as well.

A study published earlier this year demonstrated that the gender identity of transgender children is deeply held and consistent rather than the result of confusion as many people have previously maintained.

Finally Published in the Journal of Adolescent Health, the study of more than 100 transgender youths found that their hormone levels between the ages of 12-24 were consistent with the gender they were assigned at birth.