Avaliação de níveis séricos de hematócrito, hormonais e metabólicos em homens trans em uso de terapia hormonal de afirmação de gênero: o tipo de testosterona importa?

Abstract

Gender-affirming hormone therapy (GAHT) is one of the main pillars of clinical care for transgender people, aiming to align phenotypic characteristics with gender identity. Among transgender men (trans men), GAHT is performed using androgens. One relevant aspect of treatment is the potential negative impact on metabolic parameters and the increased thromboembolic risk associated with elevated hematocrit levels. This study aimed to investigate the impact of different testosterone formulations on hematocrit, hormone levels, and metabolic parameters in trans men followed at a reference outpatient service for transgender health. A retrospective analysis was conducted including 122 medical records of trans men followed at the Reference Center for Comprehensive Transgender Health Care of the Clinical Hospital of the Federal University of Uberlândia (CRAIST) between 2017 and 2024. Participants were divided into three groups: continuous use of long-acting testosterone (n = 30), short-acting testosterone (n = 67), and individuals transitioning from a short-acting to a long-acting regimen (n = 29). Hormone levels, hematocrit, lipid profile, fasting glucose, and liver function were evaluated, as well as the association between smoking and elevated hematocrit levels (≥50%) across different testosterone regimens. When comparing short-acting and long-acting testosterone users, a statistically significant difference was observed in serum testosterone levels, which were higher in the short-acting group (p = 0.02922). No statistically significant differences were identified between the groups regarding hematocrit, glucose, estradiol, total cholesterol, HDL, LDL, triglycerides, or liver function. Likewise, no statistically significant association was observed between smoking and hematocrit ≥50%. In paired analyses of individuals who transitioned from short-acting to long-acting testosterone, no relevant changes in testosterone or hematocrit levels were observed. The similarity in hematocrit levels between the groups may be related to sample size. Based on these findings, it cannot be ruled out that short-acting testosterone formulations may demonstrate hematocrit elevation in larger samples, reinforcing the need for continuous clinical monitoring and highlighting the importance of further studies to better understand differences between hormonal regimens.