Sex reassignment surgery combined with female hormone therapy may protect the metabolic health of transgender women, researchers suggest.
Previous research has suggested that transgender women are at greater risk for cardiovascular disease and type 2 diabetes, compared with men and women among the general population.
Some studies have put this increased risk down to female hormone therapy; therapy with the female hormone estrogen, for example, has been linked to high blood pressure and increased risk of stroke and heart attack.
For this latest study, lead author Michael Nelson, PhD, of the Cedars-Sinai Medical Center in Los Angeles, CA, and colleagues set out to determine whether this metabolic risk varied depending on the type of therapy used make the male-to-female transition.
The team enrolled 12 transgender women to their study, four of whom were receiving female hormone therapy and eight of whom received a combination of female hormone therapy and bilateral orchiectomy - in which both testicles are surgically removed.
The researchers measured the insulin resistance and the accumulation of fat in the liver of each participant. They explain that insulin resistance is a key sign of poor metabolic health, and build-up of fat in the liver can cause nonalcoholic fatty liver disease - which studies have suggested can increase heart disease risk.
Bilateral orchiectomy may benefit metabolic health
Compared with transgender women who received female hormone therapy alone, those who received both female hormone therapy and bilateral orchiectomy were found to have better metabolic health.
Specifically, the team found that transgender women only receiving hormone therapy had greater insulin resistance and greater accumulation of fat in the liver than those who received both surgery and female hormone therapy.
Transgender women who had the highest levels of testosterone were found to have the poorest metabolic health, according to the researchers.
In addition, the team found that the amount of fat build-up in the liver was linked to the level of insulin resistance; whether the two are associated is an ongoing subject of debate in the medical world.
Overall, the researchers say their findings indicate transgender women who undergo bilateral orchiectomy may be protected against insulin resistance and fat build-up in the liver, while the two conditions are more likely to develop among those who receive hormone therapy alone.
Earlier this year, Medical News Today reported on a study that found transgender children do not have a hormone imbalance.
Published in the Journal of Adolescent Health, the study of more than 100 transgender youths found that their hormone levels between the ages of 12-24 were consistent with the gender they were assigned at birth.