Injectable Estradiol Use in Transgender and Gender-Diverse Individuals throughout the United States

被引：2

作者：

Misakian, Aaron L. ^{[1
]}

Kelley, Carly E. ^{[2
]}

Sullivan, Erika A. ^{[3
]}

Chang, Julia J. ^{[4
]}

Singh, Gagandeep ^{[5
]}

Kokosa, Sarah ^{[2
]}

Avila, Jonathan ^{[6
]}

Cooper, Holly ^{[1
]}

Liang, Jane W. ^{[7
]}

Botzheim, Bren ^{[7
]}

Quint, Meg ^{[8
]}

Jeevananthan, Athavi ^{[2
]}

Chi, Ellenor ^{[9
]}

Harmer, Madison ^{[9
]}

Hiatt, Laurel ^{[10
]}

Kowalewski, Michaela ^{[9
]}

Steinberg, Benjamin ^{[9
]}

Tausinga, Telisha ^{[9
]}

Tanner, Hannah ^{[9
]}

Ho, Tiffany F.

Mark, Bayarmaa ^{[9
]}

Zenger, Brian ^{[7
,9
]}

Hu, Sophia ^{[11
]}

Gebregzabheir, Amanuail ^{[12
,13
]}

Penny, Justin M.

Loeb, Danielle F. ^{[12
,13
,14
]}

Strickland, Tyler ^{[12
,13
]}

Iwamoto, Sean J. ^{[12
,13
,15
]}

Rothman, Micol S. ^{[12
,13
]}

Hamnvik, Ole-Petter R. ^{[16
]}

Ariel, Danit ^{[4
]}

机构：

[1] Stanford Univ, Sch Med, Sch Med, Stanford, CA 94304 USA

[2] Duke Univ, Med Ctr, Div Endocrinol Metab & Nutr, Durham, NC 27710 USA

[3] Univ Utah, Sch Med, Dept Family & Prevent Med, Salt Lake City, UT 84108 USA

[4] Stanford Univ, Sch Med, Div Endocrinol Gerontol & Metab, Stanford, CA 94305 USA

[5] Univ Minnesota, Dept Family Med & Community Hlth, Minneapolis, MN 55455 USA

[6] Stanford Univ, Sch Med, Div Adolescent Med, Stanford, CA 94304 USA

[7] Stanford Univ, Sch Med, Stanford, CA 94304 USA

[8] Univ Michigan, Dept Epidemiol, Ann Arbor, MI 48109 USA

[9] Univ Utah, Sch Med, Salt Lake City, UT 84108 USA

[10] Univ Utah, Sch Med, Dept Human Genet, Salt Lake City, UT 84108 USA

[11] Harvard Med Sch, Brigham & Womens Hosp, Div Plast Surg, Boston, MA 02115 USA

[12] Univ Colorado, Sch Med, Dept Med, Div Endocrinol Metab & Diabet, Aurora, CO 80045 USA

[13] Univ Colorado, Sch Med, Dept Med, Div Endocrinol Metab & Diabet,Gender Divers Progra, Aurora, CO 80045 USA

[14] Icahn Sch Med Mt Sinai, Div Gen Internal Med, New York, NY 10029 USA

[15] Rocky Mt Reg Vet Affairs Med Ctr, Med Serv, Endocrinol Sect, Aurora, CO 80045 USA

[16] Harvard Med Sch, Brigham & Womens Hosp, Div Endocrinol Diabet & Hypertens, Boston, MA 02115 USA

来源：

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM | 2025年

关键词：

estradiol injections; gender-affirming hormone therapy; transgender; estradiol cypionate; estradiol valerate; TESTOSTERONE; PHARMACOLOGY;

D O I：

10.1210/clinem/dgaf015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context: Guidelines for use of injectable estradiol esters (valerate [EV] and cypionate [EC]) among transgender and gender-diverse (TGD) individuals designated male at birth vary considerably, with many providers noting supraphysiologic serum estradiol concentrations based on current dosing recommendations. Objectives: This work aimed to 1. determine the dose of injectable estradiol (subcutaneous [SC] and intramuscular [IM]) needed to reach guideline-recommended estradiol concentrations for TGD adults using EC/EV; 2. describe the relationship between estradiol concentration relative to timing/dose of last estradiol injection and other covariates; and 3. determine dosing differences between IM/SC EV/EC. Methods: A cross-sectional retrospective study was conducted across 6 US medical centers including TGD adults on same-dose injectable estradiol for more than 75 days, with confirmed timing of estradiol concentration relative to last injection, from January 1, 2019 to December 31, 2023. Descriptive statistics were used to describe patient characteristics and weighted linear mixed models to evaluate relationship between various covariates and estradiol concentration. Results: Data from 562 patients were included. Among those injecting every 7 days who reached the guideline-recommended estradiol concentration (n = 131, 27.5%), the median estradiol dose was 4.0 mg (interquartile range, 3.0-5.0 mg). Among all patients, the majority reached supraphysiologic estradiol concentrations (>200 pg/mL [>734 pmol/L]) while dose and timing in the injection cycle were significant covariates for the estradiol concentration. There were no significant dosing differences between IM/SC EV/EC. Conclusion: Injectable estradiol esters effectively reach guideline-recommended estradiol concentrations but at lower doses than previously recommended. Estradiol concentrations are best interpreted relative to timing of last injection. Route of administration and type of ester do not significantly affect estradiol concentrations.

引用

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