Abstract
Purpose: Chronic gender-affirming hormone therapy (GAHT) with sublingual estradiol (SLE) has not been studied. We aimed to compare GAHT with SLE only, to combined oral (CO) estradiol and cyproterone acetate, in treatment-naive trans women.
Methods: Twenty-two trans women enrolled into either the CO arm or the SLE-only arm (0.5 mg four times daily) in this 6-month prospective study. Anthropometric and laboratory variables were collected at baseline and 3 and 6 months. At the study beginning and end, body composition was measured by dual-energy X-ray absorptiometry and bioelectrical impedance, and gender dysphoria, sexual desire, and function were assessed by validated questionnaires.
Results: Subjects in the SLE were older, 26.3±5.8 years versus 20.1±2.3 years, p=0.006. All anthropometric, body composition, and laboratory variables were identical at baseline. Although dysphoria appeared greater, and sexual function lower at baseline in the CO group, this canceled out after age adjustment. Both treatments induced similar biochemical and hormonal changes. Creatinine, hemoglobin and cholesterol decreased significantly, while testosterone was suppressed to the same level in both groups: 3.22 [1.47-5.0] nmol/L in the SLE group and 2.41 [0.55-8.5] nmol/L in the CO, p=0.65. Significant changes in body composition toward a more feminine body were noted in both groups. Dysphoria did not significantly improve in either group, while sexual desire and function decreased at six months in both, p<0.001.
Conclusions: Both treatments achieved similar clinical changes. At this stage, SLE, which repeatedly induces alarming excursions of serum estradiol throughout the day, appears to offer no advantage over the CO approach.
We will get back to this more fully soon. However, we appreciate you actully engaging with us about the negative stuff. We find much of the time the rest of the trans community doesn’t want to engage with this kind of stuff and a lot of the time it feels like they’re saying “shut up, we only want positivity.”
It helps to work through this stuff where we’re not being told to shut up, condescended to, demeaned or being told to be happy with what we have or might get which is what happens all too often for some reason.
I was worried you might feel I was somehow dismissing your needs, so hopefully my response did not feel dismissive. I was just hoping to show that how even if those are your needs, that satisficing might still make sense here. It probably helps that I have some similar feelings as you, it is painful to me that I will never be a cis woman. For years I dismissed the possibility of transition because I could never be a cis woman, but I still affirm my transition - life is better for it.
I hope not to be demeaning, condescending, etc. but I admit I can sometimes mess up or not see how something I say comes across - hopefully you will grant me grace in those moments if they do occur. Also, I am sorry that you feel alienated this way in the community, but it is my experience that the trans community is filled with negative emotions and especially accounts of dysphoria as you just gave. At the very least, you are hardly alone in your “negativity”. :-)