跨性别男性的性别确认激素治疗及其安全监测

doi:10.12280/gjszjk.20230329

摘要/Abstract

摘要：

性别确认激素治疗（gender affirming hormone therapy，GAHT）是跨性别者进行性别转化不可避免且最为主要的方式，治疗安全性需要更多关注。对于跨性别男性，雄激素的使用无疑会影响其生理指标，甚至会导致一些不良反应。每12周1 000 mg肌内注射十一酸睾酮，是目前世界各国跨性别男性主流的GAHT方案，安全性、有效性、经济性和方便性综合最佳；跨性别男性的GAHT，应监测其血细胞比容、肝功能、血脂、血压、瘦体质量、体质量指数和骨密度等，避免雄激素过量引起的不良事件。本文综述跨性别男性GAHT及其安全监测，旨在为中国跨性别男性GAHT的安全合理用药提供参考。

关键词: 跨性别男性, 性别确认激素治疗, 睾酮, 安全监测, 治疗

Abstract:

Gender-affirming hormone therapy (GAHT) is the inevitable and most important way for transgender people to undergo gender transition, while the safety of hormone therapy needs more attention. For transgender men, the use of androgen (male hormone) will undoubtedly affect their physiological indicators, and even lead to some adverse reactions. For transgender men, intramuscular injection of testosterone undecanoate (TU) 1 000 mg every 12 weeks is currently the mainstream GAHT program in the world, with the best safety, effectiveness, economy and convenience. The GAHT of transgender men should be monitored for hematocrit, liver function, blood lipids, blood pressure, lean body mass, body mass index, bone mineral density, etc., to avoid the possible adverse events caused by excess androgen. This paper reviewed the GAHT of transgender men and its safety monitoring, and provided a reference for safe and rational use of GAHT for Chinese transgender men.

Key words: Transgender men, Gender-affirming hormone therapy, Testosterone, Safety monitoring, Therapy

宿凌, 蔡玮瑶, 何佳欣, 高绿芬. 跨性别男性的性别确认激素治疗及其安全监测[J]. 国际生殖健康/计划生育杂志, 2023, 42(6): 476-480.

SU Ling, CAI Wei-yao, HE Jia-xin, GAO Lyu-fen. Safety Monitoring of Gender-Affirming Hormone Therapy in Transgender Men[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(6): 476-480.

图/表 1

参考文献 20

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剂型	药品名称	优缺点	指南推荐方案
剂型	药品名称	优缺点	世界跨性别健康专业协会（WPATH）	欧洲性医学学会科学委员会（ESSM）	美国内分泌协会（ENDO）	韩国
注射制剂	庚酸睾酮注射剂	优点：疗效好、便宜；缺点：注射部位不适、血清睾酮水平容易波动、红细胞增多症风险大	每2周100~200 mg肌内注射或每周50~100 mg皮下注射	每2~3周200~250 mg肌内注射或每周75~125 mg皮下注射	每2周100~200 mg肌内注射或每周50~100 mg皮下注射	每2周100~200 mg肌内注射，或每3~4周250 mg肌内注射，或每周50~100 mg皮下注射
	环丙酸睾酮注射剂	优点：疗效好、抑制月经方面效果好、血清睾酮水平比较平稳；缺点：注射疼痛较大、红细胞增多症风险大	每2周100~200 mg肌内注射或每周50~100 mg皮下注射	每2~3周200~250 mg肌内注射或每周75~125 mg皮下注射	每2周100~200 mg肌内注射或每周50~100 mg皮下注射	每2周100~200 mg肌内注射，或每3~4周250 mg肌内注射，或每周50~100 mg皮下注射
	十一酸睾酮注射剂	优点：长效、疗效好、便宜；缺点：注射部位不适、红细胞增多症风险大	每12周1 000 mg肌内注射或每10周750 mg肌内注射	每10~12周1 000 mg肌内注射或每周75~125 mg皮下注射	每12周1 000 mg肌内注射	每12周1 000 mg肌内注射
透皮制剂	睾酮凝胶	优点：方便、剂量随时调整、红细胞增多症风险小；肝毒性小；缺点：经皮肤传递给他人、皮肤敏感者出现红斑、贵	1.6%：50~100 mg/d	25~100 mg/d	1.6%：50~100 mg/d	2.0%：30~80 mg/d
	睾酮鼻凝胶	-	-	-	-	22~33 mg/d
	睾酮透皮贴剂	优点：方便、剂量随时调整、红细胞增多症风险小、肝毒性小；缺点：皮肤过敏、瘙痒、不适感、贵	2.5~7.5 mg/d	-	2.5~7.5 mg/d	-
口服制剂	十一酸睾酮软胶囊	优点：方便、剂量随时调整；缺点：吸收差、容易漏服	每天1~2次口服，总剂量160 mg	每天1~2次口服，总剂量160 mg	-	-

剂型	药品名称	优缺点	指南推荐方案
剂型	药品名称	优缺点	世界跨性别健康专业协会（WPATH）	欧洲性医学学会科学委员会（ESSM）	美国内分泌协会（ENDO）	韩国
注射制剂	庚酸睾酮注射剂	优点：疗效好、便宜；缺点：注射部位不适、血清睾酮水平容易波动、红细胞增多症风险大	每2周100~200 mg肌内注射或每周50~100 mg皮下注射	每2~3周200~250 mg肌内注射或每周75~125 mg皮下注射	每2周100~200 mg肌内注射或每周50~100 mg皮下注射	每2周100~200 mg肌内注射，或每3~4周250 mg肌内注射，或每周50~100 mg皮下注射
	环丙酸睾酮注射剂	优点：疗效好、抑制月经方面效果好、血清睾酮水平比较平稳；缺点：注射疼痛较大、红细胞增多症风险大	每2周100~200 mg肌内注射或每周50~100 mg皮下注射	每2~3周200~250 mg肌内注射或每周75~125 mg皮下注射	每2周100~200 mg肌内注射或每周50~100 mg皮下注射	每2周100~200 mg肌内注射，或每3~4周250 mg肌内注射，或每周50~100 mg皮下注射
	十一酸睾酮注射剂	优点：长效、疗效好、便宜；缺点：注射部位不适、红细胞增多症风险大	每12周1 000 mg肌内注射或每10周750 mg肌内注射	每10~12周1 000 mg肌内注射或每周75~125 mg皮下注射	每12周1 000 mg肌内注射	每12周1 000 mg肌内注射
透皮制剂	睾酮凝胶	优点：方便、剂量随时调整、红细胞增多症风险小；肝毒性小；缺点：经皮肤传递给他人、皮肤敏感者出现红斑、贵	1.6%：50~100 mg/d	25~100 mg/d	1.6%：50~100 mg/d	2.0%：30~80 mg/d
	睾酮鼻凝胶	-	-	-	-	22~33 mg/d
	睾酮透皮贴剂	优点：方便、剂量随时调整、红细胞增多症风险小、肝毒性小；缺点：皮肤过敏、瘙痒、不适感、贵	2.5~7.5 mg/d	-	2.5~7.5 mg/d	-
口服制剂	十一酸睾酮软胶囊	优点：方便、剂量随时调整；缺点：吸收差、容易漏服	每天1~2次口服，总剂量160 mg	每天1~2次口服，总剂量160 mg	-	-