Endocrine Abstracts

Background: Gender-affirming hormone treatment (GAHT) is the cornerstone in the therapeutic management of transgender and gender diverse (TGD) people, which are currently classified as transgender assigned-female-at birth (t-AFAB) and assigned-male-at birth (t-AMAB) subjects. Due to its hormonal nature, GAHT is commonly handled by the endocrinologist and available guidelines on this topic mimic the recommendations for cis-gender hypogonadal populations. However, the GAHT long term management remains challenging, since the clinician must juggle a balance between achieving the phenotypic characteristics of the perceived gender and minimizing adverse effects. Although several longitudinal studies evaluated GAHT approaches, a focus on the challenges that the clinician should face off is still lacking.

Aim: Of the study: To investigate the long term therapeutic management of TGD people, considering hormonal targets, treatment adjustments and GAHT safety.

Methods: A retrospective, longitudinal, observational, multicentre clinical study was carried out, enrolling TGD subjects consecutively attending two Italian Endocrinology Units (Turin and Modena) from 2005 until 2022. Both t-AFAB and t-AMAB subjects were included, recording all data derived from routine outpatient evaluations. Each subject was managed with specific and personalized follow-up depending on the clinical practice of the Centre, as well as on the presence of adverse events, in accordance to the guidelines in force.

Results: Comprehensively, 302 t-AFAB and 453 t-AMAB were enrolled, showing similar follow-up average duration (P=0.974) and visits number (P=0.384). However, hormonal targets were reached more frequently in t-AFAB (63.6%) rather than in t-AMAB (23.3%) subjects. In addition, less time (P=0.002), fewer follow-up visits (P=0.006) and less changes in therapeutic schemes (P=0.024) were required in t-AFAB to achieve the therapeutic goal. Accordingly, t-AFAB showed a higher adherence to medical prescriptions compared to t-AMAB subjects (P<0.001). During follow-up, the rate of both hypertension (P=0.015) and dyslipidaemia (P<0.001) increased in t-AFAB subjects, whereas t-AMAB ones showed a significant increase only in dyslipidaemia rate (P<0.001). No significantly increased rate of cardiovascular events was detected in both groups.

Discussion: Here, we described for the first time a long term follow-up during GAHT in a large cohort of Italian TGD people. This real-world clinical snapshot shows that hormonal balance is reached more frequently and more easily in transgender AFAB compared to AMAB subjects. Probably, these latter would require a thicker clinical management to overcome the higher intrinsic complexity of feminizing treatments, at least contributing to the poor therapeutic adherence observed in such subjects.