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Botdichtheid bij transgenders na gonadectomie en langdurige behandeling met hormoontherapie.

(2015) Vink, P. (Patti)

Purpose:
This retrospective cohortstudy studied the effect of longterm hormonal therapy and
gonadetomy on bone mineral density (BMD) in transgenders.
Materials & Methods:
56 male-to-female (M-F) and 32 female-to-male (F-M) transgenders were
included in this study. They had all been treated with hormonal substitution (HT) had undergone
gonadectomy, and one or more Dual energy X-ray absorptiometry (DEXA)- scans had been
performed to evaluate BMD. M-F transgenders were treated with estrogens, some combined with
anti-androgens, F-M transgenders were treated with androgens. A total of 169 DEXA-scans were
analysed, with a median duration of HT of 135 months (with a minimum of 26 months and a
maximum of 373 months) at the time the DEXA-scan was performed. We distinguished between
the group as a whole, in which at least 1 DEXA-scan had been performed, and the follow-up group,
in which 2 or more DEXA-scans had been performed. We only used the first DEXA-scan while
analysing the group as a whole, while for the follow-up group the first and last DEXA-scan were
compared. BMD was measured at the radius, lumbar spine (LS) and proximal femur. Laboratory
values that had been established within 3 months of perfoming a DEXA-scan were analysed.
Demographic variables were collected from patient statuses.
Results:
M-F teansgenders were significantly older and taller than F-M transgenders. M-F
transgenders had a significantly higher BMD at the radius than F-M transgenders. F-M transgenders
had a significantly higher BMD at the lumbar spine than M-F transgenders. 22,4% of M-F
transgenders had osteoporosis for the male gender during the first DEXA-scan, compared to 8% of
F-M transgenders with osteoporosis for the female gender.
In the M-F follow-up group a significant increase in BMD was found at the radius and the LS. In
the F-M follow-up group a significant increase in BMD was found at the radius. By performing
linear regression analyses no significant correlations were found between duration of HT and time
since SRS, and BMD for both M-F and F-M transgenders.
An inverse correlation was found between Luteinizing hormone (LH) and follicle stimulating
hormone (FSH), and BMD for both M-F and F-M transgenders.
Conclusion:
This study supports previously described findings that BMD is maintained or
increases in transgenders who have undergone SRS and are adequately substituted with sex
hormones. A high prevalence of osteoporosis was found in M-F transgenders at the first DEXAscan
(22,4%) which justifies the performance of DEXA-scans in transgenders. LH and FSH values
were found to be good markers for establishing whether adequate hormonal substition was present.





ID 2806
Moeder ID 2263
Volgorde Vink, P.
Naam VinkP
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2015/VinkP/
Gemaakt op: 2015-07-07 09:06:01
Gemodificeerd op: 2015-07-07 09:06:01
Digitaal ID 559b96849fece
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel Botdichtheid bij transgenders na gonadectomie en langdurige behandeling met hormoontherapie.
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 34
Publicatiejaar 2015
Taal nl
Engelse samenvatting Purpose:
This retrospective cohortstudy studied the effect of longterm hormonal therapy and
gonadetomy on bone mineral density (BMD) in transgenders.
Materials & Methods:
56 male-to-female (M-F) and 32 female-to-male (F-M) transgenders were
included in this study. They had all been treated with hormonal substitution (HT) had undergone
gonadectomy, and one or more Dual energy X-ray absorptiometry (DEXA)- scans had been
performed to evaluate BMD. M-F transgenders were treated with estrogens, some combined with
anti-androgens, F-M transgenders were treated with androgens. A total of 169 DEXA-scans were
analysed, with a median duration of HT of 135 months (with a minimum of 26 months and a
maximum of 373 months) at the time the DEXA-scan was performed. We distinguished between
the group as a whole, in which at least 1 DEXA-scan had been performed, and the follow-up group,
in which 2 or more DEXA-scans had been performed. We only used the first DEXA-scan while
analysing the group as a whole, while for the follow-up group the first and last DEXA-scan were
compared. BMD was measured at the radius, lumbar spine (LS) and proximal femur. Laboratory
values that had been established within 3 months of perfoming a DEXA-scan were analysed.
Demographic variables were collected from patient statuses.
Results:
M-F teansgenders were significantly older and taller than F-M transgenders. M-F
transgenders had a significantly higher BMD at the radius than F-M transgenders. F-M transgenders
had a significantly higher BMD at the lumbar spine than M-F transgenders. 22,4% of M-F
transgenders had osteoporosis for the male gender during the first DEXA-scan, compared to 8% of
F-M transgenders with osteoporosis for the female gender.
In the M-F follow-up group a significant increase in BMD was found at the radius and the LS. In
the F-M follow-up group a significant increase in BMD was found at the radius. By performing
linear regression analyses no significant correlations were found between duration of HT and time
since SRS, and BMD for both M-F and F-M transgenders.
An inverse correlation was found between Luteinizing hormone (LH) and follicle stimulating
hormone (FSH), and BMD for both M-F and F-M transgenders.
Conclusion:
This study supports previously described findings that BMD is maintained or
increases in transgenders who have undergone SRS and are adequately substituted with sex
hormones. A high prevalence of osteoporosis was found in M-F transgenders at the first DEXAscan
(22,4%) which justifies the performance of DEXA-scans in transgenders. LH and FSH values
were found to be good markers for establishing whether adequate hormonal substition was present.
Nederlandse samenvatting Doel:
Dit retrospectieve cohortonderzoek onderzocht het effect van langdurige hormoontherapie en
gonadectomie op de botdichtheid van transgenders.
Materiaal & Methoden:
Er werden 56 man-naar-vrouw (M-V) en 32 vrouw-naar-man (V-M)
transgenders geïncludeerd. Zij werden behandeld met hormoontherapie (HT), hadden gonadectomie
middels geslachtsaanpassende operatie (sex reassignment surgery, SRS) ondergaan en volgens
protocol was tenminste éénmaal de botdichtheid (bone mineral density, BMD) gemeten middels
Dual Energy X-ray Absorptiometry (DEXA). Er werden in totaal 169 DEXA-scans geanalyseerd,
waarvan de mediane duur van HT ten tijde van het verrichten van de DEXA-scan 135 maanden
bedroeg, met een mininum van 26 maanden en een maximum van 373 maanden. HT bestond bij MV
transgenders uit oestrogenen, al dan niet gecombineerd met anti-androgenen, bij V-M
transgenders bestond HT uit androgenen. Er werd onderscheid gemaakt tussen de totale groep,
waarbij tenminste 1 DEXA-scan was verricht, en de follow-up groep, waarbij 2 of meer DEXAscans
waren verricht. In de totale groep werd alleen naar de eerste DEXA-scan gekeken, in de
follow-up groep werden de eerst en laatst verrichte DEXA-scan met elkaar vergeleken. BMD werd
gemeten ter hoogte van de radius, de lumbale wervelkolom (LWK) en het proximale femur.
Laboratoriumwaarden die binnen 3 maanden van het verrichten van een DEXA-scan waren
verkregen werden meegenomen in dit onderzoek. Demografische variabelen werden verkregen uit
patiëntenstatussen.
Resultaten:
In de totale groep waren M-V transgenders significant ouder en langer dan V-M
transgenders. M-V transgenders hadden een significant hogere BMD ter hoogte van de radius dan
V-M transgenders. V-M transgenders hadden een significant hogere BMD ter hoogte van de LWK
dan M-V transgenders. Bij 22,4% van M-V transgenders was er sprake van osteoporose voor het
mannelijk geslacht, bij 8% van V-M transgenders was er sprake van osteoporose voor het
vrouwelijk geslacht. In de M-V follow-up groep werd een significante toename van de BMD ter
hoogte van de radius en de LWK waargenomen ten tijde van de laatste DEXA-scan. In de V-M
follow-up groep werd een significante toename van de BMD waargenomen ter hoogte van de
radius. Middels lineaire regressieanalyses werden geen significante correlaties gevonden tussen
duur van HT en tijd verstreken sinds SRS, en de BMD, bij zowel M-V als V-M transgenders. Er
werd een inverse correlatie gevonden tussen luteïniserend hormoon (LH) en follikel stimulerend
hormoon (FSH), en de BMD, bij zowel M-V als V-M transgenders.
Conclusie:
Deze studie bevestigt eerder in de literatuur beschreven bevindingen dat BMD
behouden blijft of stijgt bij transgenders die adequate hormoontherapie gebruiken en SRS hebben
ondergaan. In deze studie werd een hoge prevalentie van osteoporose bij M-V transgenders
gevonden (22,4%), wat het protocollair verrichten van DEXA-scans rechtvaardigt. LH- en FSHwaardes
bleken in deze studie goede markers te zijn om vast te stellen of er sprake is van adequate
hormonale substitutie.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Vink, P. (Patti)
UMCG begeleider(s) Weijmar Schultz, Prof. dr. W.C.M.; Slart, Prof. dr. R.H.J.A.; Tuuk, Mevr. dr. K. v/d; Berg, Mevr. dr. M. v/d
Auteur(s) Vink, P. (Patti)
UMCG begeleider(s) Weijmar Schultz, Prof. dr. W.C.M.; Slart, Prof. dr. R.H.J.A.; Tuuk, Mevr. dr. K. v, d; Berg, Mevr. dr. M. v, d


 
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