Terapia hormonal cruzada, densidade mineral óssea e composição corporal em indivíduos transgêneros

A disforia de gênero é definida pela incongruência entre o sexo de nascimento e o sexo de identidade, com duração superior a 6 meses. Esta condição está associada a sofrimento pessoal e prejuízo em diferentes áreas, e os indivíduos submetidos à terapia hormonal (TH) cruzada podem apresentar melhora da qualidade de vida com o tratamento adequado. A TH cruzada tem como objetivo principal suprimir os hormônios endógenos e as características sexuais secundárias do sexo biológico e induzir características sexuais compatíveis com o sexo de identidade. Em indivíduos submetidos à cirurgia de afirmação sexual (CAS), a TH cruzada é utilizada como forma de reposição hormonal, uma vez que o procedimento gera uma situação de hipogonadismo persistente. A TH cruzada inadequada ou irregular, neste contexto, poderia acarretar prejuízo à saúde óssea e maior risco de baixa massa óssea e/ou fraturas. No que se refere às mulheres trans, os estudos mostram aumento ou preservação da densidade mineral óssea (DMO) na coluna lombar quando avaliada a massa óssea antes e após a terapia estrogênica. Quando comparadas aos controles do sexo masculino, a terapia estrogênica parece não afetar significativamente a DMO nos sítios avaliados. No presente estudo, uma elevada prevalência de baixa massa óssea foi observada em mulheres trans quando comparadas a controles de ambos os sexos. A maior parte das mulheres trans avaliada utilizava terapia estrogênica por longo período de forma irregular, e um terço já havia realizado CAS. No que se refere aos homens trans, não foi observada diferença significativa na DMO considerando a massa óssea antes e após a terapia androgênica, ou quando comparado aos controles do sexo feminino. As evidências atuais indicam que a TH cruzada não afeta a DMO em homens trans, e em mulheres trans está associada a aumento da DMO na coluna lombar. Contudo, as evidências são de baixa à moderada qualidade, e estudos com maior tempo de acompanhamento e uso regular da TH são necessários para confirmar estes dados.Gender dysphoria is defined by the incongruence between the biological sex and the sex of identity, lasting more than 6 months. This condition may be associated with personal distress and impairment in different areas, and individuals undergoing cross-sex hormone therapy (CSHT) may have improvement in quality of life with appropriate treatment. The main objective of CSHT is to suppress endogenous hormone secretion and the sex characteristics of the expressed gender and maintain sex hormone levels and sex characteristics consistent with the other gender. In individuals undergoing gender affirmation surgery (GAS), CSHT is used as hormone replacement, since the procedure generates a condition of persistent hypogonadism. Inadequate or irregular CSHT in this context could lead to bone health impairment and increased risk of low bone mass and / or fractures. Regarding trans women, studies showed a preservation or increase in bone mineral density (BMD) in the lumbar spine when evaluated bone mass before and after estrogen therapy. When compared to male controls, estrogen therapy did not significantly affect BMD at any site evaluated. In our study, higher prevalence of low bone mass was observed in trans women compared to natal men and women. Most of the trans women evaluated used irregular estrogen therapy for long period, and a third had already performed CAS. Regarding trans men, no significant difference was observed in BMD considering bone mass before and after androgen therapy, or when compared to female controls. Current evidence indicates that CSHT does not affect BMD in trans men, and in trans women it is associated with increased BMD in lumbar spine. However, the evidence is of low and moderate quality and further studies with regular CSHT and longer follow-up are needed to confirm this data in trans women

Effect of Intranasal Calcitonin in a Patient with McCune-Albright Syndrome, Fibrous Dysplasia, and Refractory Bone Pain

McCune-Albright syndrome (MAS) is a rare disease defined by the triad of polyostotic fibrous dysplasia of bone, café-au-lait skin spots, and precocious puberty. No available treatment is effective in changing the course of fibrous dysplasia of bone, but symptomatic patients require therapeutic support to reduce bone pain and prevent fractures and deformities. We report the case of a 27-year-old woman with MAS and severe fibrous dysplasia. She was diagnosed with MAS at 4 years of age and, during follow-up, she had multiple pathological fractures and bone pain refractory to treatment with bisphosphonates, tricyclic antidepressants, and opioids. The pain was incapacitating and the patient required a wheelchair. Intranasal calcitonin was then started, and, 30 days later, the patient already showed significant improvement in pain severity at the affected sites. After 3 months, she was able to walk without assistance. No adverse effects were observed, nor were any significant changes in serum levels of calcium, phosphorus, and alkaline phosphatase. Calcitonin has a well-recognized analgesic effect on bone tissue. Despite the small number of studies involving patients with MAS, calcitonin may be considered a short-term therapeutic option in cases of severe and refractory bone pain

Effect of intranasal calcitonin in a patient with McCune-Albright Syndrome, fibrous dysplasia, and refractory bone pain

McCune-Albright syndrome (MAS) is a rare disease defined by the triad of polyostotic fibrous dysplasia of bone, caf´e-au-lait skin spots, and precocious puberty. No available treatment is effective in changing the course of fibrous dysplasia of bone, but symptomatic patients require therapeutic support to reduce bone pain and prevent fractures and deformities.We report the case of a 27-year-old woman withMAS and severe fibrous dysplasia. She was diagnosed withMAS at 4 years of age and, during follow-up, she had multiple pathological fractures and bone pain refractory to treatment with bisphosphonates, tricyclic antidepressants, and opioids. The pain was incapacitating and the patient required a wheelchair. Intranasal calcitonin was then started, and, 30 days later, the patient already showed significant improvement in pain severity at the affected sites. After 3 months, she was able to walk without assistance. No adverse effects were observed, nor were any significant changes in serum levels of calcium, phosphorus, and alkaline phosphatase. Calcitonin has a well-recognized analgesic effect on bone tissue. Despite the small number of studies involving patients with MAS, calcitonin may be considered a short-term therapeutic option in cases of severe and refractory bone pain

Lean mass and associated factors in women with PCOS with different phenotypes

Although current evidence suggests increased risk of obesity, insulin resistance, and meta- bolic alterations in patients with polycystic ovary syndrome (PCOS), especially of a hyperan- drogenic phenotype, the impact of each one of these variables on muscle mass remains uncertain. In this case-control study, we evaluated clinical and hormonal characteristics related to lean body mass according to the different PCOS phenotypes. We performed clini- cal, metabolic, and hormonal assessments and evaluated body compartments by dual- energy X-ray absorptiometry in 133 women of reproductive age. Creatinine served as an indirect marker of lean mass. Median age was 28 (range, 17–37) years. Women with pheno- types A and B (n = 59) had higher body mass index (BMI) and metabolic syndrome preva- lence than those with phenotype C (n = 23) and controls (n = 51) (p<0.005). Women with phenotypes A and B also had higher Ferriman-Gallwey score (p<0.001), insulin levels (p = 0.006), HOMA-IR (p = 0.008), testosterone (p = 0.008), free androgen index (FAI) (p<0.001), fat mass index (FMI) (p = 0.015), android-to-gynoid fat ratio (p = 0.036), and bone mineral density (BMD) at lumbar spine (p = 0.027) and total femur (p = 0.013) than controls. Median appendicular lean mass index (ALMI) was higher in phenotypes A and B than in controls (7.01 [IQR, 6.33–8.02] vs. 6.69 [IQR, 5.94–7.09], p = 0.024), but it did not dif- fer significantly from that in phenotype C (6.60 [IQR, 6.16–7.22], p = 0.222). Even after adjusting for BMI, ALMI correlated positively with creatinine in women with phenotypes A and B (rho = 0.319, p = 0.023) but not in those with phenotype C (p = 0.238) or controls (p = 0.097). In multivariate linear regression analyses, ALMI was positively associated with insulin, FAI, FMI, and total femur BMD. The present results suggest that fasting insulin, FAI, fat mass, and total femur BMD were positively associated with increased lean mass in women with PCOS phenotypes A and B

Physical and sociodemographic features associated with quality of life among transgender women and men using gender-affirming hormone therapy

Background: Gender dysphoria is defined as a feeling of distress resulting from the incongruence between the sex assigned at birth and the gender identity, lasting longer than 6 months. In individuals with gender dysphoria, gender-affirming hormone therapy (GAHT) may improve quality of life (QoL). Objectives: We aimed to assess perceived QoL, to compare QoL scores between trans women and men and to identify possible contributing factors related to GAHT in a sample of transgender women and transgender men. Methods: In this cross-sectional study, transgender women and men were recruited by availability sampling from a national transgender health service. Individuals over 18 years old with a confirmed diagnosis of gender dysphoria receiving medically prescribed GAHT for at least 6 months were consecutively included. Also included were trans men who had undergone mastectomy and trans women who had received breast augmentation surgery. Individuals who had undergone gender affirmation surgery (specifically genital surgery) or with uncontrolled clinical/psychiatric conditions at the time of the initial assessment were excluded. Sociodemographic, physical, and hormone data were collected from all participants. The WHOQOL-BREF questionnaire was used to evaluate QoL. A total of 135 transgender individuals were invited. Seventeen individuals with previous genital surgery (12.6%) and five who refused to participate (3.7%) were excluded. Therefore, 113 patients were enrolled and completed the study (60 trans women and 53 trans men). Results: QoL scores did not differ between trans women and trans men. In trans women, greater breast development and stable relationships, and higher body mass index were associated with higher QoL domain scores. In trans men, higher domain scores were found in individuals in a stable relationship, with increased body hair, engaging in physical activity, and being employed. Conclusion: Data from this study suggest that GAHT-related physical characteristics, such as breast development in trans women and increased body hair in trans men, are similar between groups, are associated with higher QoL scores, and that sociodemographic parameters may impact these associations. Healthcare providers might consider these factors when planning interventions to improve QoL in transgender individuals