Hormone levels among transgender women and transgender men in a transgender-led, integrated, gender-affirming care and sexual health service at Tangerine Clinic in Bangkok, Thailand: a real-world analysis


BACKGROUND: Gender-affirming hormone therapy (GAHT) is used among many transgender individuals who would like to achieve physical changes'feminizing hormone therapy (FHT) for transgender women and masculinizing hormone therapy (MHT) for transgender men. Without proper monitoring, GAHT can lead to suboptimal effect or put users at risk for adverse events. We aimed to determine hormone levels among transgender women and transgender men who were using GAHT.
METHODS: Transgender individuals who were using GAHT at entry to Tangerine Clinic and tested for hormone levels (blood estradiol [E2] and total testosterone [TT] levels for transgender women; TT for transgender men) between 2015 and 2020 were included. Hormone target levels were E2 of 100'200 pg/mL and TT of <50 ng/dL for transgender women; TT of 400-700 ng/dL for transgender men. Baseline and available hormone levels during the 12-month follow-up period were assessed to determine changes.
RESULTS: A total of 1,534 transgender women were included: 2.5% underwent orchiectomy, 70.8% used single-hormone regimen, and 5% were HIV-positive. Median E2 and TT levels at baseline were 29 (14.3'45.3) pg/mL and 298.5 (22'646) ng/dL, respectively. A total of 524 (32.2%) had any hormones within target levels: 28 (1.8%), both; 11 (0.7%), only E2; and 485 (31.6%), only TT. HIV status was not associated with the outcome of hormone target levels. Among 302 transgender women who came to follow-up visit(s), 165 (54.6%) achieved or maintained either hormone within target levels. A total of 200 transgender men were included: none had gender-affirming surgery and all were HIV-negative. Median (IQR) TT levels were 45.5 (32.5'531.6) ng/dL, and 141 (70.5%), 26 (13.0%), 33 (16.5%) had suboptimal, optimal, and supraphysiologic TT levels, respectively. Median hematocrit was significantly higher among those with optimal or supraphysiologic TT levels compared to those with suboptimal TT levels (46.7 vs. 41.0% and 47.0 vs. 41.0 %, respectively, p<0.001 in both comparisons), and seven had erythrocytosis. Median high-density lipoprotein cholesterol (HDL) levels were significantly higher among transgender men with suboptimal TT levels compared to those with supraphysiologic levels (61 vs. 50.5 mg/dL, p=0.02). Among 152 transgender men who came to follow-up visit(s), 51 (33.6%) achieved or maintained optimal TT levels.
CONCLUSIONS: One-third of transgender women who were using FHT had any hormones within target levels and 13% of transgender men who were using MHT had optimal TT levels in this real-world analysis. At follow-up visits, there was an increase in the proportion with optimal hormone levels for both transgender groups, emphasizing a positive effect of supervised GAHT in a transgender-competent health care facility.