激素治疗如何影响变性人的心脏健康?

Cardiovascular health in transgender people requires a multifaceted approach to care, according to a new report that looked at a range of issues in how hormone therapy affects heart health.

这项研究周一发表在美国心脏协会杂志上 Hypertension, set out to create a guidepost for future medical care by examining past research on hormone therapy and transgender individuals, 在美国，每200人中就有1人是这样的人.S.

“这是一个非常独特的情况, 这方面的文献也不多,该研究的主要作者说, Dr. 基督教戴尔.

“我们已经知道性激素对心血管健康很重要, and now we have people being exposed to high levels of sex hormones they normally would not have, 哪些与心血管有益或危险有关. 如果有风险的话, 我们必须找出风险有多大，以及我们如何管理它," said Delles, a professor at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow.

在回顾了几十项研究之后, the researchers concluded the use of estrogen by transgender women may be associated with an increased risk of heart attack and ischemic stroke. 另一方面, the use of testosterone by transgender men did not seem to increase cardiovascular risk.

Dr. Paul Connelly, 研究人员之一, 说这些发现有些出乎意料, because estrogen is thought to reduce inflammation and have a protective effect on the vascular system, while testosterone is thought to have a more mixed effect with some negative impact on cardiovascular health.

"How we think these sex hormones act within the vascular system is really not what we're seeing in transgender patients as a whole,康纳利说。, 他是格拉斯哥大学的临床研究员. "It opens a lot of questions about how we can limit any potential risk and allow transgender adults to have better evidence based-guidance to manage their health."

The study focused on gender hormone therapy's affect on cardiovascular health, but it also concluded that hormone therapy also impacts bone metabolism and the risk of malignancy. As a result, "a cross-disciplinary approach is required to provide transgender people with optimal care,报告说.

It also concluded there wasn't enough evidence to assess the long-term effects of "pubertal suppression,或者在青春期使用药物来抑制性激素. The report also said questions remain about whether researchers should compare transgender individuals with people of their birth sex or their adopted gender.

杰·西维利斯是华盛顿大学的教授 Center of Excellence for Transgender Health at the University of California in San Francisco, called the study "a really important paper because it highlights the gaps in what we don't know and provides a springboard  for future research."

Sevelius, 谁没有参与这项研究, said the paper points to the need for doctors and researchers "to take a community participatory approach … It's important to make sure that we're speaking the language of the trans community, 给他们准确的信息, and also asking them 'What do you think the most pressing research questions are?'"

A 2015 survey showed about a quarter of transgender people don't seek preventive care because they fear discrimination.

Sevelius said it's essential doctors stay well-informed and open-minded when treating transgender patients.

“一些不完全了解跨性别医疗保健的医生可能会, 是出于好意, 告诉一个吸烟的变性女人“当你戒烟的时候”, 我们可以给你注射这些激素,不明白激素本身可以挽救生命, 病人应该在知情的情况下做出决定," she said.

康纳利同意. "Probably the most important thing is to make the transgender community aware that we're not trying to reduce access to treatment, but to offer them a way to use hormones safely and lower any potential risk to their cardiovascular health," he said.

降低风险的关键是大规模开展, in-depth studies that could untangle the mysteries of how gender hormone therapy affects health. 该研究称，未来对这一主题的研究是“迫切需要的”.

世界各地, 性别认同诊所正变得越来越普遍，使用率也越来越高,康纳利说. "So, this is really a public health opportunity to get in at the ground floor and improve the health of a population that is not only larger than we once thought, 但它正在扩张."

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