Endocrine Abstracts

JOINT1138

Objective: Evidence about hepatic risk profile of gender affirming hormone therapy (GAHT) is low. Most previous studies are small, retrospective and focused on the assessment of liver enzymes. Our objective was to challenge fewer findings with prospective data using modern investigation methods. We analysed the impact of GAHT on metabolic risk factors and on the development of pathological remodeling in the liver

Design: Prospective cohort study in 39 transgender individuals (20 transmen and 19 transwomen). Data were collected from 2021 to 2023.

Methods: Sonographic examinations including CAP (controlled attenuation parameter) measurement and transient elastography, the current non-invasive gold standard methods to evaluate the development of metabolic-associated fatty liver disease (MAFLD) and MAFLD-related fibrosis, were performed in all participants. Furthermore, we assessed parameters of glucose and lipid metabolism. Data were gathered each before and one year after initiation of GAHT. A relevant increase, respectively decrease was defined, if values changed > 50 % of the respective standard deviation of the baseline value.

Results: Median age of the participants was 24.3 + 7.2 years. 16.7 % of the cohort were obese, defined by a BMI > 30 kg/m². While BMI increased during the first year of GAHT (P = 0.024), we could exclude an increase of fasting glucose (P <0.001) as well as HbA1c (P = 0.006). In transmen, we recorded an increase in LDL- (P = 0.016) and a decrease in HDL-cholesterol (P <0.001), however, all parameter remained within the reference range. Triglycerides showed a trend to increase in transmen and to decrease in transwomen, but results were not significant and parameter remained within the reference ranges. Sonographic methods could exclude an increase of liver steatosis (P = 0.001) as well as fibrosis (P <0.001).

Conclusion: Neither virilising nor feminising gender affirming hormone therapy is a risk factor for the development of MAFLD or MAFLD-related fibrosis within the first year. A further measurement after five years of therapy will per performed to evaluate long-term effects.