Toward a Lowest Effective Dose of Cyproterone Acetate in Trans Women: Results From the ENIGI Study
| Autor: | Elfi B. Conemans, Alessandra D. Fisher, Suzanne M E Kuijpers, Chantal M. Wiepjes, Guy T'Sjoen, Martin den Heijer |
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| Přispěvatelé: | Internal medicine, APH - Aging & Later Life, Amsterdam Gastroenterology Endocrinology Metabolism |
| Rok vydání: | 2021 |
| Předmět: |
Male
Endocrinology Diabetes and Metabolism Clinical Biochemistry cyproterone acetate THERAPY Biochemistry Cohort Studies chemistry.chemical_compound 0302 clinical medicine Endocrinology SEX HORMONE-TREATMENT Belgium Medicine and Health Sciences Medicine ENDOCRINE Longitudinal Studies 030212 general & internal medicine Gender Dysphoria Prospective cohort study Testosterone Netherlands trans people Gender Identity Cyproterone acetate Effective dose (pharmacology) Treatment Outcome Italy Female anti-androgen medicine.medical_specialty Hormone Replacement Therapy 030209 endocrinology & metabolism Context (language use) 03 medical and health sciences Internal medicine Humans Cyproterone Acetate SUPPRESSION VENOUS THROMBOEMBOLISM hormone therapy Dose-Response Relationship Drug business.industry Biochemistry (medical) Androgen Antagonists Prolactin Androgen receptor chemistry Sex Reassignment Procedures testosterone business Transsexualism Lipoprotein |
| Zdroj: | Journal of Clinical Endocrinology and Metabolism, 106(10), E3936-E3945. The Endocrine Society JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Kuijpers, S M E, Wiepjes, C M, Conemans, E B, Fisher, A D, Tsjoen, G & den Heijer, M 2021, ' Toward a Lowest Effective Dose of Cyproterone Acetate in Trans Women : Results from the ENIGI Study ', Journal of Clinical Endocrinology and Metabolism, vol. 106, no. 10, pp. E3936-E3945 . https://doi.org/10.1210/clinem/dgab427 |
| ISSN: | 1945-7197 0021-972X |
| Popis: | Context Cyproterone acetate (CPA) is a competitive inhibitor of the androgen receptor and exerts negative hypothalamic feedback. It is often used in combination with estrogens in trans women to achieve feminization. However, CPA has been associated with side effects such as changes in liver enzyme concentrations and increases in prolactin concentrations. The question is whether the testosterone-lowering effect, as well as these side effects, are dose dependent. Objective To assess the lowest effective dose of CPA in trans women to prevent side effects. Methods This longitudinal study, conducted at gender identity centers in Amsterdam, Ghent, and Florence, is part of the European Network for the Investigation of Gender Incongruence (ENIGI), a multicenter prospective cohort study. Participants were trans women (n = 882) using estrogens only or in combination with 10, 25, 50, or 100 mg CPA daily. The primary outcome measure was the concentration of testosterone at 3 and/or 12 months of hormone therapy. Results Using estrogens only (without CPA) led to testosterone concentrations of 5.5 nmol/L (standard error of the mean [SEM] 0.3). All doses of CPA resulted in testosterone concentrations below the predefined threshold of suppression of 2 nmol/L (10 mg, 0.9 nmol/L, SEM 0.7; 25 mg, 0.9 nmol/L, SEM 0.1; 50mg, 1.1 nmol/L, SEM 0.1; 100 mg, 0.9 nmol/L, SEM 0.7). Higher prolactin and lower high-density lipoprotein concentrations were observed with increasing doses of CPA. No differences in liver enzyme concentrations were found between the doses. Conclusion Compared with higher doses of CPA, a daily dose of 10 mg is equally effective in lowering testosterone concentrations in trans women, while showing fewer side effects. |
| Databáze: | OpenAIRE |
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