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Abstract

Background: Gender dysphoria is defined as a feeling of distress resulting from the incongruence between the gender assigned at birth and the identity gender and lasting longer than 6 months. In individuals with gender dysphoria, gender-affirming hormone therapy(GAHT) may improve quality of life (QoL). Objectives: Here, we aimed to assess perceived QoL and possible contributing factors in a sample of transgender women and transgender men using GAHT. Methods: In this cross-sectional study, transgender women and men were recruited by availability sampling from a national transgender health service. Individuals over 18 years old with a confirmed diagnosis of gender dysphoria receiving medically prescribed GAHT for at least 6 months were consecutively included. Also included were trans men who had undergone mastectomy and trans women who had received breast augmentation surgery. Individuals who had undergone gender affirmation surgery (specifically genital surgery) or with uncontrolled clinical/psychiatric conditions at the time of the initial assessment were excluded. Sociodemographic, physical, and hormone data were collected from all participants. The WHOQOL-BREF questionnaire was used to evaluate QoL. A total of 135 transgender individuals were invited. Seventeen individuals with previous genital surgery (12.6%) and five who refused to participate (3.7%) were excluded. Therefore, 113 patients were enrolled in the study (60 trans women and 53 trans men). Results: There was no significant difference in QoLbetween the groups. In trans women, greater breast development and stable relationships, and higher body mass index were associated with higher QoLdomain scores. In trans men, higher domain scores were found in individuals with a stable relationship, increased body hair, physical activity practice, and being employed. Conclusion: Data from this study suggest that GAHT-related physical characteristics are associated with higher QoLscores, and that sociodemographic parameters may impact these associations. Healthcare providers might consider these factors when planning interventions to improve QoLin transgender individuals.
A794 | Journal of the Endocrine Society | doi: 10.1210/jendso/bvab048
J Endocrine Soc, Volume 5, Issue Supplement_1, April-May 2021 A794
persons were more likely to receive partial HT than bi-
nary transgender people (11% versus 4.7%, p=0.02). None
of the NBGQ individuals who received partial HT had
undergone gonadectomy, hypogonadism did not occur.
NBGQ individuals assigned male at birth using only es-
tradiol had similar estradiol and higher testosterone
serum concentrations compared with individuals using
conventional HT. Conclusions: NBGQ individuals are
more likely to receive partial HT compared with binary
transgender people. In the future, tailored endocrine coun-
seling may further shape partial HT regimens for NBGQ
individuals.
Reproductive Endocrinology
TRANSGENDER CARE
Patient Characteristics Associated With the Receipt
of Hormone Therapy Among Transgender Patients in
the Veterans Health Administration
DeniseH.Wong, MD1, VarshaG.Vimalananda, MD, MPH2,
JoelI.Reisman, AB2, SowmyaR.Rao, PhD3, JillianC.Shipherd,
PhD4, HillL.Wolfe, MPA2, JohnR.Blosnich, PhD, MPH5,
NicholasA.Livingston, PhD4, GuneetK.Jasuja, PhD, MPH2.
1Boston University School of Medicine, Boston, MA, USA,
2VA Bedford Healthcare System, Bedford, MA, USA, 3Boston
University School of Public Health, Boston, MA, USA, 4VA Boston
Healthcare System, Boston, MA, USA, 5VA Pittsburgh Healthcare
System, Pittsburgh, PA, USA.
Background: Many transgender patients experience
gender dysphoria as a result of an incongruence between
their gender identity and sex assigned at birth. Gender-
affirming hormone therapy improves the quality of life
for transgender patients seeking to increase alignment of
their secondary sex characteristics and gender identity.
However, little is known about the patient factors that are
associated with receipt of this therapy which is critical to
identifying areas for improvement in care for transgender
patients. Objective: To evaluate patient characteristics
associated with transgender patients’ receipt of hormone
therapy from the Veterans Health Administration (VHA).
Methods: Inpatient and outpatient data were reviewed
for transgender patients, identified through ICD-9/ICD-
10 diagnosis codes for gender identity disorder (GID), re-
ceiving VHA health care from January 2006 to December
2018. We evaluated receipt of hormone therapy (testos-
terone or estrogen +/- spironolactone) from the VHA,
socio-demographics, comorbidities, social stressors, mil-
itary sexual trauma, and documented suicide attempts.
Adjusted Odds Ratios (aOR) and 95% Confidence Intervals
(CI) were obtained from a multivariable logistic regres-
sion model used to ascertain the relationship between
patient characteristics and hormone therapy. Results:
Of 9,406 patients with documented GID, 5,487 (58.3%)
received hormone therapy from the VHA. Compared to
patients not receiving hormone therapy, a higher propor-
tion of patients receiving hormone therapy were younger
(21-29 years: 18.1% vs. 11.6%; 30-39 years: 20.0% vs.
14.6%; 40-49years: 16.2% vs. 13.6%), had documentation
of a positive military sexual trauma screening (22.2% vs.
16.2%; p<0.0001), and a suicide attempt (11.4% vs. 9.9%;
p=0.0067). There were significant associations between
receipt of hormone therapy and: 1) younger age (aOR:
1.33; 95% CI: 1.29-1.36; p<0.0001); 2)Black non-Hispanic
patients (aOR: 0.58; 95% CI: 050-0.68; p<0.0001);
3) increasing number of comorbidities (aOR: 0.86; 95%
CI: 0.84-0.88; p<0.0001); and 4)increasing number of so-
cial stressors (aOR: 0.86; 95% CI: 0.83-0.90; p<0.0001).
Conclusions: Age, race/ethnicity, comorbidities, and so-
cial stressors among other factors are associated with
receipt of hormone therapy among transgender patients
in the VHA. Subsequent efforts should focus on under-
standing clinician- and site-level determinants to facili-
tate the design of effective quality improvement measures
that optimize gender affirming hormone therapy through
VHA for transgender patients.
Reproductive Endocrinology
TRANSGENDER CARE
Physical and Sociodemographic Features Associated
With Quality of Life in Transgender Individuals
Using Gender-Affirming HormoneTherapy
ElianeDiasDaSilva, MSc1, TayaneMunizFighera, MD,
PhD2, RobertaMartinsCostaMoreiraAllgayer, MD3,
MariaInêsRodriguesLobato, MD, PhD2, PoliMaraSpritzer, MD,
PhD4.
1UFRGS, Porto Alegre, Brazil, 2Federal University of Rio Grande
do Sul (UFRGS), PORTO ALEGRE, Brazil, 3Federal University
of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, 4University
Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.
Background: Gender dysphoria is defined as a feeling
of distress resulting from the incongruence between the
gender assigned at birth and the identity gender and
lasting longer than 6months. In individuals with gender
dysphoria, gender-affirming hormone therapy(GAHT)
may improve quality of life (QoL). Objectives: Here, we
aimed to assess perceived QoL and possible contributing
factors in a sample of transgender women and trans-
gender men using GAHT. Methods: In this cross-sec-
tional study, transgender women and men were recruited
by availability sampling from a national transgender
health service. Individuals over 18years old with a con-
firmed diagnosis of gender dysphoria receiving medically
prescribed GAHT for at least 6 months were consecu-
tively included. Also included were trans men who had
undergone mastectomy and trans women who had re-
ceived breast augmentation surgery. Individuals who
had undergone gender affirmation surgery (specifically
genital surgery) or with uncontrolled clinical/psychi-
atric conditions at the time of the initial assessment
were excluded. Sociodemographic, physical, and hormone
data were collected from all participants. The WHOQOL-
BREF questionnaire was used to evaluate QoL. Atotal
of 135 transgender individuals were invited. Seventeen
individuals with previous genital surgery (12.6%) and five
who refused to participate (3.7%) were excluded. Therefore,
113 patients were enrolled in the study (60 trans women
and 53 trans men). Results: There was no significant
Downloaded from https://academic.oup.com/jes/article/5/Supplement_1/A794/6241189 by guest on 12 July 2021
doi: 10.1210/jendso/bvab048 | Journal of the Endocrine Society | A795
J Endocrine Soc, Volume 5, Issue Supplement_1, April-May 2021
A795
difference in QoLbetween the groups. In trans women,
greater breast development and stable relationships,
and higher body mass index were associated with higher
QoLdomain scores. In trans men, higher domain scores
were found in individuals with a stable relationship,
increased body hair, physical activity practice, and being
employed. Conclusion: Data from this study suggest that
GAHT-related physical characteristics are associated with
higher QoLscores, and that sociodemographic parameters
may impact these associations. Healthcare providers
might consider these factors when planning interventions
to improve QoLin transgender individuals.
Reproductive Endocrinology
TRANSGENDER CARE
Prolactinoma in a Male to Female Transgender
Woman on Gender Affirming HormoneTherapy
LeightonK.Harned, MD1, ReneJ.Harper, MD2.
1Medical College of Georgia Endocrine Fellowship Program,
Augusta, GA, USA, 2Augusta University, Augusta, GA, USA.
Background: Estrogen promotes prolactin secretion and
its role in prolactin secreting adenomas is still under inves-
tigation. The genesis and resolution of prolactinomas may
be affected by gender affirming hormone therapy.
Case Description: A 50 year old transgender female
presented with new onset tunnel vision and extremity
parathesias for one day. She had been taking oral estrogen
for six years. Physical exam showed bilateral gynecomastia
as well as galactorrhea. Her visual fields were intact by
confrontation.
Her brain MRI revealed a pituitary macroadenoma meas-
uring 1.4cm x 1.3cm x 1.3cm. Laboratory studies showed
prolactin 538 ng/mL (<20ng/mL), IGF-1 89.0 (66-303ng/
ml). TSH 1.7 (0.4-4.7 mcIU/mL), Free T4 0.997 (0.58-
1.76ng/dL) and estradiol 103 pg/ml(N/A).
She was treated with bromocriptine 5mg daily. Three
months later galactorrhea had resolved, but gyneco-
mastia was unchanged. The patient had a prolactin level
of 3ng/mL. Follow up brain MRI at one and three years
showed no significant decrease in size of macroadenoma.
Discussion: Despite this patient’s biochemical and symp-
tomatic response to dopamine agonist therapy, her pi-
tuitary adenoma did not decrease in size over 3 years,
which is a common occurrence with macroprolactinomas.
However, her prolactin levels declined and her galactor-
rhea resolved with therapy. Research into the long term
effects of gender transition therapy remains mainly in the
realm of case reports and retrospective studies. Our review
of the medical literature suggests that some transgender
patients on estrogen therapy may have an increased risk
of developing pituitary adenomas. However, guidelines
have not yet been published and currently there are no
recommendations for routine imaging or biochemical as-
sessment during follow-up of these patients. While there
are established reference ranges for prolactin levels for
men, non-pregnant and pregnant women, no established
reference ranges for prolactin levels are available for
transgender women on gender affirming hormone therapy.
Studies indicate that 76-86% of patients have a reduction
in the size of their prolactinomas after dopamine agonist
therapy. However, the same may not be true for trans-
gender women on transfeminine hormone therapy with
estrogen.
Conclusion: Prolactinomas may commonly occur and be
masked in transgender women on gender affirming hor-
mone therapy due to the expected symptoms of gyneco-
mastia, erectile dysfunction, and diminished libido from
reduced testosterone levels. Estrogen promotes prolactin
secretion by the pituitary gland and may have a role in de-
velopment and expansion of prolactinomas. More research
is needed in regards to the assessment and monitoring
of the pituitary gland in transgender women on gender
affirming hormone therapy with estrogen.
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