ORCID Profile
0000-0001-8836-165X
Current Organisations
Austin Hospital
,
Bond University
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Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJOPEN-2022-060869
Abstract: Gender affirming hormone therapy (GAHT) is increasingly used by transgender in iduals and leads to shifts in sex hormone levels. Skeletal muscle is highly responsive to hormone activity, with limited data on the effects of GAHT on different human tissues. Here, we present the protocol for the GAME study (the effects of G ender A ffirming hormone therapy on skeletal M uscle training and E pigenetics), which aims to uncover the effects of GAHT on skeletal muscle ‘omic’ profiles (methylomics, transcriptomics, proteomics, metabolomics) and markers of skeletal muscle health and fitness. This study is a prospective age-matched cohort study in transgender adults commencing GAHT (n=80) and age-matched in iduals not commencing GAHT (n=80), conducted at Austin Health and Victoria University in Victoria, Australia. Assessments will take place prior to beginning GAHT and 6 and 12 months into therapies in adults commencing GAHT. Age-matched in iduals will be assessed at the same time points. Assessments will be ided over three examination days, involving (1) aerobic fitness tests, (2) muscle strength assessments and (3) collection of blood and muscle s les, as well as body composition measurements. Standardised diets, fitness watches and questionnaires will be used to control for key confounders in analyses. Primary outcomes are changes in aerobic fitness and muscle strength, as well as changes in skeletal muscle DNA methylation and gene expression profiles. Secondary outcomes include changes in skeletal muscle characteristics, proteomics, body composition and blood markers. Linear mixed models will be used to assess changes in outcomes, while accounting for repeated measures within participants and adjusting for known confounders. The Austin Health Human Research Ethics Committee (HREC) and Victoria University HREC granted approval for this study (HREC/77146/Austin-2021). Findings from this project will be published in open-access, peer-reviewed journals and presented to scientific and public audiences. ACTRN12621001415897 Pre-results.
Publisher: Medknow
Date: 2017
Publisher: Wiley
Date: 06-2016
DOI: 10.1002/CCR3.590
Publisher: Wiley
Date: 11-05-2021
DOI: 10.1111/DOM.14409
Abstract: Obesity is highly prevalent worldwide, including among people with chronic kidney disease (CKD). The presence of severe and/or end‐stage kidney disease complicates the treatment of obesity for several reasons, including restrictions on protein and fluid intake and renal excretion of several medications indicated for the treatment of obesity. The aim of this review is to assess the safety of intensive obesity treatments, such as very‐low‐energy diets (VLEDs), obesity pharmacotherapy and/or bariatric surgery, in people with end‐stage kidney disease. A literature search was conducted to identify studies reporting safety outcomes for VLEDs, liraglutide, phentermine, phentermine‐topiramate, naltrexone‐bupropion and bariatric surgery in people with an estimated glomerular filtration rate of less than 30 mL/min/1.73m 2 or on dialysis. Limited data were insufficient to recommend VLEDs but highlighted their potential efficacy and the need for close clinical and biochemical monitoring. There were no data regarding centrally acting obesity pharmacotherapy in this population, although some glucagon‐like peptide‐1 analogues appear to safely induce weight loss at doses used for the treatment of type 2 diabetes. Some studies suggest an increased rate of complications of bariatric surgery in in iduals with severe or end‐stage CKD. Further prospective evaluation of intensive obesity management in the growing population with obesity and severe, end‐stage and dialysis‐dependent CKD is required.
Publisher: The Endocrine Society
Date: 27-11-2021
Abstract: Preclinical data has shown progesterone metabolites improve sleep parameters through positive allosteric modulation of the γ-aminobutyric acid type A receptor. We undertook a systematic review and meta-analysis of randomized controlled trials to assess micronized progesterone treatment on sleep outcomes. Using preferred reporting items for systematic review and meta-analysis guidelines, we searched MEDLINE, Embase, PsycInfo, and the Cochrane Central Register of Controlled Trials for randomized controlled trials of micronized progesterone treatment on sleep outcomes up to March 31, 2020. This study is registered with the International Prospective Register of Systematic Reviews, number CRD42020165981. A random effects model was used for quantitative analysis. Our search strategy retrieved 9 randomized controlled trials comprising 388 participants. One additional unpublished trial was found. Eight trials enrolled postmenopausal women. Compared with placebo, micronized progesterone improved various sleep parameters as measured by polysomnography, including total sleep time and sleep onset latency, though studies were inconsistent. Meta-analysis of 4 trials favored micronized progesterone for sleep onset latency (effect size, 7.10 confidence interval [CI] 1.30, 12.91) but not total sleep time (effect size, 20.72 CI -0.16, 41.59) or sleep efficiency (effect size, 1.31 CI -2.09, 4.70). Self-reported sleep outcomes improved in most trials. Concomitant estradiol administration and improvement in vasomotor symptoms limit conclusions in some studies. Micronized progesterone improves various sleep outcomes in randomized controlled trials, predominantly in studies enrolling postmenopausal women. Further research could evaluate the efficacy of micronized progesterone monotherapy using polysomnography or validated questionnaires in larger cohorts.
Publisher: The Endocrine Society
Date: 05-03-2019
Abstract: Diabetic ketoacidosis (DKA) has been associated with the use of sodium glucose cotransporter 2 inhibitors (SGLT2is). To determine the incidence, characteristics, and outcomes of DKA in SGLT2i users vs nonusers with type 2 diabetes. Retrospective, multicenter, controlled cohort study. All public hospitals in Melbourne and Geelong (combined population of 5 million), Australia, from 1 September 2015 to 31 October 2017. Consecutive cases of DKA that developed in the community, or during the course of hospital admission, in patients with type 2 diabetes. In SGLT2i users vs nonusers: (i) OR of DKA developing during hospital admission, and (ii) incidence of DKA. There were 162 cases of DKA (37 SGLT2i users and 125 non-SGLT2i users) with a physician-adjudicated diagnosis of type 2 diabetes. Of these, DKA developed during the course of inpatient admission in 14 (38%) SGLT2i users vs 2 (2%) non-SGLT2i users (OR, 37.4 95% CI, 8.0 to 175.9 P < 0.0001). The incidence of DKA was 1.02 per 1000 (95% CI, 0.74 to 1.41 per 1000) in SGLT2i users vs 0.69 per 1000 (95% CI, 0.58 to 0.82 per 1000) in non-SGLT2i users (OR, 1.48 95% CI, 1.02 to 2.15 P = 0.037). Fifteen SGLT2i users (41%) had peak blood glucose <250 mg/dL (14 mmol/L) compared with one (0.8%) non-SGLT2i user (P < 0.001). SGLT2i users were more likely to develop DKA as an inpatient compared with non-SGLT2i users. SGLT2i use was associated with a small but significant increased risk of DKA.
Publisher: The Endocrine Society
Date: 13-07-2023
Abstract: The inclusion of transgender people in elite sport has been a topic of debate. This narrative review examines the impact of gender-affirming hormone therapy (GAHT) on physical performance, muscle strength, and markers of endurance. MEDLINE and Embase were searched using terms to define the population (transgender), intervention (GAHT), and physical performance outcomes. Existing literature comprises cross-sectional or small uncontrolled longitudinal studies of short duration. In nonathletic trans men starting testosterone therapy, within 1 year, muscle mass and strength increased and, by 3 years, physical performance (push-ups, sit-ups, run time) improved to the level of cisgender men. In nonathletic trans women, feminizing hormone therapy increased fat mass by approximately 30% and decreased muscle mass by approximately 5% after 12 months, and steadily declined beyond 3 years. While absolute lean mass remains higher in trans women, relative percentage lean mass and fat mass (and muscle strength corrected for lean mass), hemoglobin, and VO2 peak corrected for weight was no different to cisgender women. After 2 years of GAHT, no advantage was observed for physical performance measured by running time or in trans women. By 4 years, there was no advantage in sit-ups. While push-up performance declined in trans women, a statistical advantage remained relative to cisgender women. Limited evidence suggests that physical performance of nonathletic trans people who have undergone GAHT for at least 2 years approaches that of cisgender controls. Further controlled longitudinal research is needed in trans athletes and nonathletes.
Publisher: Springer Science and Business Media LLC
Date: 03-01-2018
DOI: 10.1007/S12020-017-1505-0
Abstract: The ACTH Case-control study in a clinical research facility. Eighty-seven patients with suspected cortisol deficiency, twenty-four healthy controls, and ten healthy women on the oral contraceptive (OC) underwent an intravenous 250 µg ACTH There was a significant difference in serum cortisol between the healthy volunteers and the women on the OC (P < 0.001) but no difference in salivary cortisol. The lower limit of the reference interval for salivary cortisol at 60 min was 26 nmol/L. 27/89 (30%) of tests with suspected HPA axis disorder failed the 60 min serum cortisol cut-off of 500 nmol/L. Of these, 24/27 (89%) had a salivary cortisol of <26 nmol/L. In contrast, 12/19 (63%) tests and 5/43 (12%) tests where the 60 min serum cortisol was 500-599 and ≥600 nmol/L, respectively had a salivary cortisol of <26 nmol/L. Salivary cortisol provides additional diagnostic value during the 250 µg ACTH
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/20420188231178373
Abstract: Many transgender (trans) in iduals utilize gender-affirming hormone therapy (GAHT) to promote changes in secondary sex characteristics to affirm their gender. Participation rates of trans people in sport are exceedingly low, yet given high rates of depression and increased cardiovascular risk, the potential benefits of sports participation are great. In this review, we provide an overview of the evidence surrounding the effects of GAHT on multiple performance-related phenotypes, as well as current limitations. Whilst data is clear that there are differences between males and females, there is a lack of quality evidence assessing the impact of GAHT on athletic performance. Twelve months of GAHT leads to testosterone concentrations that align with reference ranges of the affirmed gender. Feminizing GAHT in trans women increases fat mass and decreases lean mass, with opposite effects observed in trans men with masculinizing GAHT. In trans men, an increase in muscle strength and athletic performance is observed. In trans women, muscle strength is shown to decrease or not change following 12 months of GAHT. Haemoglobin, a measure of oxygen transport, changes to that of the affirmed gender within 6 months of GAHT, with very limited data to suggest possible reductions in maximal oxygen uptake as a result of feminizing GAHT. Current limitations of this field include a lack of long-term studies, adequate group comparisons and adjustment for confounding factors (e.g. height and lean body mass), and small s le sizes. There also remains limited data on endurance, cardiac or respiratory function, with further longitudinal studies on GAHT needed to address current limitations and provide more robust data to inform inclusive and fair sporting programmes, policies and guidelines.
Publisher: Wiley
Date: 12-03-2021
Abstract: To identify glucocorticoid‐responsive proteins measurable in human serum that may have clinical utility in therapeutic drug monitoring and the diagnosis of cortisol excess or deficiency. A phased biomarker discovery strategy was conducted in two cohorts. Secretome from peripheral blood mononuclear cells (PBMC) isolated from six volunteers after ex vivo incubation ± dexamethasone (DEX) 100 ng/mL for 4 h and 24 h was used for candidate discovery and qualification using untargeted proteomics and a custom multiple reaction monitoring mass spectrometry (MRM‐MS) assay, respectively. For validation, five candidates were measured by immunoassay in serum from an independent cohort ( n = 20), s led at 1200 h before and after 4 mg oral DEX. The discovery secretome proteomics data generated a shortlist of 45 candidates, with 43 measured in the final MRM‐MS assay. Differential analysis revealed 16 proteins that were significant in at least one of two time points. In the validation cohort, 3/5 serum proteins were DEX‐responsive, two significantly decreased: lysozyme C ( p 0.0001) and nucleophosmin‐1 ( p 0.01), while high mobility group box 2 significantly increased ( p 0.01). Using an ex vivo proteomic approach in PBMC, we have identified circulating glucocorticoid‐responsive proteins which may have potential as serum biomarkers of glucocorticoid activity.
Publisher: Informa UK Limited
Date: 03-04-2023
Publisher: Elsevier BV
Date: 09-2020
Publisher: Wiley
Date: 15-04-2022
DOI: 10.1111/CEN.14734
Abstract: Previous studies have suggested a higher prevalence of Klinefelter syndrome amongst transgender in iduals. We undertook a systematic review to determine the prevalence of Klinefelter syndrome amongst transgender in iduals presumed male at birth and summarize the clinical features and potential treatment implications for in iduals with Klinefelter syndrome commencing gender‐affirming hormone therapy. Using preferred reporting items for systematic review and meta‐analysis guidelines, we searched EMBASE, MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) up to 31 December 2021. All studies reporting on the prevalence or clinical features of transgender in iduals with Klinefelter syndrome were included. This study is registered with the International Prospective Register of Systematic Reviews, number CRD42021227916. Our search strategy retrieved 11 cohort studies comprising 1376 transgender in iduals. In all, 14 of 1376 (1.02%) in iduals were diagnosed with Klinefelter syndrome. Based on the seven studies in which karyotype was undertaken in all in iduals, the prevalence is 9/1013 (0.88% 95% CI, 0.41%−1.68%). Case reports highlight unique treatment considerations in this population, including azoospermia, venous thromboembolism, and monitoring of breast cancer and bone health. Compared to the general population, observational studies document a higher prevalence of Klinefelter syndrome amongst transgender in iduals, though underdiagnosis in the general population limits conclusions. Routine karyotype in transgender people initiating gender‐affirming hormone therapy is not supported unless clinical features of Klinefelter syndrome, such as small testicular volume, or hypergonadotropic hypogonadism are present. Transgender in iduals with Klinefelter syndrome need to manage a unique risk profile if they desire feminizing gender‐affirming hormone therapy.
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/20420188221083512
Abstract: Masculinising hormone therapy with testosterone is used to align an in idual’s physical characteristics with their gender identity. Standard testosterone doses and formulations recommended for hypogonadal cisgender men are typically administered, although there are currently limited data evaluating the use of 1% testosterone gel in gender-affirming hormone therapy regimens. The objective of the study was to assess the prescription patterns and serum total testosterone concentrations achieved with 1% testosterone gel in trans and gender erse in iduals. A retrospective cross-sectional analysis was undertaken of trans in iduals at a primary and secondary care clinic in Melbourne, Australia. Sixty-seven in iduals treated with 1% testosterone gel were included. Primary outcomes were testosterone dose and serum total testosterone concentration achieved. Median age was 25 (22–30) years and median duration of testosterone therapy was 12 (7–40) months. Thirty-five (52%) in iduals had a nonbinary gender identity. Initial median testosterone dose was 25 mg (12.5–31.3) daily. Fifty-two (78%) in iduals commenced doses mg daily, the recommended starting dose for hypogonadal cisgender men. Median total testosterone concentration achieved was 11.9 nmol/l (7.3–18.6). Polycythaemia (haematocrit .5) was documented in eight of 138 (6%) laboratory results in six in iduals. One percent testosterone gel achieves serum total testosterone concentrations in the cisgender male reference range. A high proportion of in iduals had a nonbinary gender identity and most in iduals commenced a lower dose than that typically administered to hypogonadal cisgender men, potentially related to slow or ‘partial’ masculinisation goals.
Publisher: Frontiers Media SA
Date: 13-07-2021
DOI: 10.3389/FENDO.2021.667403
Abstract: The safety and efficacy of feminizing hormone therapy in aging transgender (trans) in iduals is unclear. Current recommendations suggest transdermal estradiol beyond the age of 45 years, especially if cardiometabolic risk factors are present. To evaluate feminizing hormone therapy regimens and cardiovascular risk factors in aging trans in iduals. Retrospective cross-sectional analysis. Primary care and endocrine specialist clinic in Melbourne, Australia. Trans in iduals on feminizing therapy for ≥6 months. Feminizing hormone regimens and serum estradiol concentrations by age group: (a) ≥45 years, (b) & years, and prevalence of cardiometabolic risk factors in in iduals ≥45 years. 296 in iduals were stratified by age group: ≥45 years ( n =55) and & years ( n =241). There was no difference in median estradiol concentration between groups (328 nmol/L vs . 300 nmol/L, p=0.22). However, there was a higher proportion of in iduals ≥45 years treated with transdermal estradiol (31% vs. 8%, p& .00001). Of those treated with oral estradiol, the median dose was lower in the ≥45 years group (4mg vs. 6mg, p=0.01). The most prevalent cardiometabolic risk factor in the ≥45 years group was hypertension (29%), followed by current smoking (24%), obesity (20%), dyslipidaemia (16%) and diabetes (9%). A greater proportion of trans in iduals ≥45 years of age were treated with transdermal estradiol. Of those who received oral estradiol, the median dose was lower. This is important given the high prevalence of cardiometabolic risk factors in this age group, however cardiovascular risk management guidelines in this demographic are lacking.
Publisher: Springer Science and Business Media LLC
Date: 14-06-2018
DOI: 10.1038/S41598-018-27481-3
Abstract: To assess the effect of testosterone treatment on bone remodelling and density in dieting obese men, 100 obese men aged 53 years (interquartile range 47–60) with a total testosterone level nmol/L receiving 10 weeks of a very low energy diet (VLED) followed by 46 weeks of weight maintenance were randomly assigned at baseline to 56 weeks of intramuscular testosterone undecanoate (n = 49, cases) or matching placebo (n = 51, controls). Pre-specified outcomes were between-group differences (mean adjusted difference, MAD) in serum c-telopeptide (CTx), N-terminal propeptide of type 1 procollagen (P1NP) and bone mineral density (BMD). At trial end, CTx was significantly reduced in men receiving testosterone compared to placebo, MAD −66 ng/L (95% CI −113, −18), p = 0.018, and this was apparent already after the 10 week VLED phase, MAD −63 ng/L (95% CI −108, −18), p = 0.018. P1NP was marginally increased after VLED, MAD +4.2 ug/L (95% CI −0.01, +8.4), p = 0.05 but lower at study end, MAD −5.6 ug/L (95% CI −10.1, −1.1), p = 0.03. No significant changes in sclerostin, lumbar spine BMD or femoral BMD were seen. We conclude that in obese men with low testosterone levels undergoing weight loss, bone remodelling markers are modulated in a way that may have favourable effects on bone mass.
Publisher: Elsevier BV
Date: 08-2020
DOI: 10.1016/J.AMJMED.2019.12.006
Abstract: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are increasingly used for the treatment of type 2 diabetes, but have been associated with ketoacidosis. We report a case series of three patients with latent autoimmune diabetes of the adult who presented with ketoacidosis, including one case with normal blood glucose levels, in the context of SGLT2 inhibitor use. Sodium-glucose co-transporter-2 inhibitors should be used with caution and close clinical monitoring in patients with latent autoimmune diabetes of the adult. A clinical risk score permits targeted autoantibody testing and should be undertaken prior to commencement of SGLT2 inhibitors or cessation of insulin.
Publisher: Bioscientifica
Date: 05-2022
DOI: 10.1530/EC-22-0170
Abstract: The role of micronised progesterone in hormone regimens for transgender in iduals undergoing feminising hormone therapy remains uncertain. We aimed to determine the effect of oral micronised progesterone on sleep quality, psychological distress, and breast development in transgender in iduals undergoing feminising hormone therapy. Prospective case–control study. Twenty-three transgender in iduals on stable oestradiol treatment newly commencing 100 mg oral progesterone ( n = 23) and controls continuing standard care ( n = 19) were assessed over 3 months. Pittsburgh Sleep Quality Index (PSQI), Kessler psychological distress scale (K10), and Tanner stage to assess breast development were assessed at 0 and 3 months. Non-parametric analysis of covariance was used to compare differences between groups. Compared with controls over 3 months, there was no difference in PSQI ( P = 0.35), K10 ( P = 0.64), or Tanner stage ( P = 0.42). There was no significant difference in the proportion of in iduals with clinically significant improvement in PSQI (25% vs 22%, P = 0.84). One in idual had a significant deterioration in psychological distress that improved following the cessation of progesterone. Low-dose progesterone was not associated with changes in sleep quality, psychological distress, or breast development over 3 months follow-up, though there was significant inter-in idual variability. Larger, placebo-controlled trials are required to further evaluate different doses of progesterone in feminising hormone therapy regimens.
Publisher: Mary Ann Liebert Inc
Date: 06-2021
Publisher: Wiley
Date: 06-2021
DOI: 10.1111/IMJ.14839
Abstract: Masculinising hormone therapy with testosterone is used to align an in idual's physical characteristics with his or her gender identity. Testosterone therapy is typically administered via intramuscular or transdermal routes, and polycythaemia is the most common adverse event. To compare the risk of polycythaemia with different formulations of testosterone therapy in transmasculine in iduals. A retrospective cross‐sectional analysis was undertaken of transmasculine in iduals at a primary and secondary care clinic in Melbourne, Australia. A total of 180 in iduals who were on testosterone therapy for months was included. Groups included those receiving: (i) intramuscular testosterone undecanoate ( n = 125) (ii) intramuscular testosterone enantate ( n = 31) or (iii) transdermal testosterone ( n = 24). Outcome was prevalence of polycythaemia (defined as haematocrit 0.5). Mean age was 28.4 (8.8) years, with a median duration of testosterone therapy of 37.7 (24.2) months 27% were smokers. There was no difference between groups in serum total testosterone concentration measured. While there was no difference between groups in haematocrit, there was a higher proportion of patients with polycythaemia in those who were on intramuscular testosterone enantate (23.3%) than on transdermal testosterone (0%), P = 0.040. There was no statistically significant difference in polycythaemia between intramuscular testosterone undecanoate (15%) and transdermal testosterone, P = 0.066 nor between intramuscular testosterone enantate and undecanoate, P = 0.275. One in four in iduals treated with intramuscular testosterone enantate and one in six treated with testosterone undecanoate had polycythaemia. No in idual treated with transdermal testosterone had polycythaemia. This highlights the importance of regular monitoring of haematocrit in transmasculine in iduals treated with testosterone, and findings may inform treatment choices.
Publisher: Springer Science and Business Media LLC
Date: 07-05-2022
DOI: 10.1007/S12020-022-03064-1
Abstract: Prader-Willi syndrome (PWS) is characterised by childhood-onset hyperphagia and obesity however limited data are available to guide treatment of obesity in this population. We aimed to evaluate the safety, tolerability, and efficacy of intensive medical weight loss interventions (very-low-energy diets [VLED] and/or pharmacotherapy) in in iduals with PWS attending a specialist obesity management service. A retrospective audit was undertaken of in iduals with PWS attending the Austin Health Weight Control Clinic between January 2010-April 2021. Main outcome measures were weight outcomes, duration of use, and adverse effects. Data were available for 18 patients, of whom 15 were treated with intensive weight loss interventions. Median (interquartile range, IQR) age at baseline was 20 years (19–32) with median body weight 90 kg (75–118) and BMI 37 kg/m 2 (30–51). Median weight loss during VLED ( n = 7) was 14 kg (1–20 kg) over 60 weeks. Median weight loss with phentermine-topiramate ( n = 7) was 17 kg (IQR 9–19 kg) over 56 weeks. Median weight loss with liraglutide 0.6–3 mg ( n = 7), prescribed with topiramate in 3 in iduals, was 9 kg (2–14 kg) over 96 weeks. Naltrexone-bupropion resulted in weight loss in 2 of 4 in iduals. Thirteen in iduals achieved ≥10% weight loss but only 5 in iduals maintained ≥10% weight loss at last follow-up. Five in iduals discontinued pharmacotherapy due to adverse effects. VLED and pharmacotherapy can achieve substantial weight loss in some in iduals with PWS though non-adherence results in substantial weight regain. Adverse effects were ascribed to phentermine and topiramate, whereas liraglutide was well-tolerated in this population.
Publisher: Wiley
Date: 09-05-2022
DOI: 10.1002/AJMG.A.62770
Abstract: Hypogonadism is the most frequent hormonal deficiency in in iduals with Prader‐Willi syndrome (PWS). This often necessitates testosterone treatment, but limited data are available to guide testosterone treatment in adult men with PWS. We aimed to evaluate the serum testosterone concentrations and adverse effects of testosterone treatment in in iduals with PWS attending a specialist obesity management service. A retrospective audit was undertaken at Austin Health, Melbourne between January 2010 and April 2021. Main outcome measures were testosterone formulation and dose, serum total testosterone concentration, and prevalence of polycythemia and behavioral disturbance. Data were available for eight in iduals with median baseline age 19 years (range, 19–42) and BMI 37 kg/m 2 (range, 27–71). Six men had obstructive sleep apnea none were smokers. Baseline testosterone concentration was 1.8 nmol/L (IQR, 1.1–3.3) with hematocrit 0.43. Testosterone formulations were intramuscular testosterone undecanoate (TU) 1000 mg ( n = 5), transdermal testosterone gel 50 mg daily ( n = 1), and oral TU 80–120 mg daily ( n = 2). Median total testosterone concentration was 9.7 nmol/L (IQR, 8.5–14.7). Nine of 25 (36%) hematocrit results in six patients measured .50 (range, 0.50–0.56). Intramuscular TU was well tolerated and was the only formulation to achieve serum total testosterone concentrations in the adult male reference range. Worsening behavioral disturbance resulted in treatment discontinuation in one in idual. Our experience reinforces the need to regular monitoring of hematocrit in men with PWS treated with testosterone. However, a worsening of behavior problems was uncommon in this series.
Publisher: SAGE Publications
Date: 2020
Abstract: Feminising hormone therapy with estradiol is used to align an in idual’s physical characteristics with their gender identity. Given considerable variations in doses of estradiol therapy administered as gender-affirming hormone therapy (GAHT), we aimed to assess if body mass index (BMI) correlated with estradiol dose/concentration and assess the correlation between estradiol dose and estradiol concentrations. In a retrospective cross-sectional study, we analysed transgender in iduals attending a primary or secondary care clinic in Melbourne, Australia who were prescribed oral estradiol valerate for at least 6 months and had estradiol dose and concentration available. Estradiol concentration was measured by immunoassay. Outcomes were the correlation between estradiol dose and BMI, and estradiol dose and estradiol concentration. Data were available for 259 in iduals {median age 25.8 [interquartile range (IQR) 21.9, 33.5] years}. Median duration of estradiol therapy was 24 (15, 33) months. Median estradiol concentration was 328 (238, 434) pmol/l [89 (65, 118) pg/ml] on 6 (4, 8) mg estradiol valerate. Median BMI was 24.7 (21.8, 28.6) kg/m 2 . There was a weak positive correlation between estradiol dose and estradiol concentration ( r = 0.156, p = 0.012). There was no correlation between BMI and estradiol concentration achieved ( r = −0.063, p = 0.413) or BMI and estradiol dose ( r = 0.048, p = 0.536). Estradiol concentrations were within the target range recommended in consensus guidelines in 172 (66%) in iduals. Estradiol dose was only weakly correlated with estradiol concentration, suggesting significant interin idual variability. Prescription of estradiol dose should not be based upon an in idual’s BMI, which did not correlate with estradiol concentration achieved. In all, 66% of in iduals achieved estradiol concentrations recommended in Australian consensus guidelines with a relatively high oral estradiol dose.
No related grants have been discovered for Brendan Nolan.