Влияние феминизирующей заместительной гормональной терапии (ЗГТ) на риски онкологических заболеваний, венозной тромбоэмболии и остеопении: систематический обзор
DOI:
https://doi.org/10.54500/2790-1203-2024-1-120-53-61Ключевые слова:
заместительная гормональная терапия, трансгендер, транссексуализм, гендерное несоответствие, гендерная дисфория, онкология, тромбоэмболия, остеопенияАннотация
Заместительная гормональная терапия (ЗГТ) является стандартным подходом к помощи пациентам с гендерным несоответствием. Целями данной терапии является подавление первичных и вторичных половых признаков исходного
пола и развитие признаков желаемого пола. ЗГТ для трансгендерных женщин обычно включает эстроген-содержащие препараты и антиандрогены. Эпидемиологические исследования показывают, что ЗГТ снижает гендерную дисфорию, улучшает психо-социальные исходы и качество жизни, связанное со здоровьем. Тем не менее, как среди пациентов, так и врачей, распространено беспокойство о безопасности такой терапии.
Систематический обзор влияния феминизирующей ЗГТ на риски онкологических заболеваний, венозной тромбоэмболии и остеопении среди трансгендерных женщин. Проведен систематический поиск в базах Web of Science, Scopus и PubMed по ключевым словам: "transgender" OR "transsexual" OR "gender dysphoria", а также "cancer" (онкологические
заболевания); "thromboembolism" OR "thromboembolic" (венозная тромбоэмболия); "osteoporosis" OR "bone" (остеопения и остеопороз).
Результаты: (а) Феминизирующая ЗГТ не приводит к повышению рисков гормонозависимых раков у
трансгендерных женщин. Незначительное повышение онкозаболеваемости в этой группе происходит за счет рака легких и, вероятно, обусловлено факторами, связанными с образом жизни, в особенности курением. (б) Современные схемы феминизирующей ЗГТ, не содержащие этинилэстрадиол, безопасны с точки зрения рисков венозной тромбоэмболии. Недостаточно данных для понимания взаимосвязи между наличием в схеме прогестинов и риском венозной тромбоэмболии. Продолжение приема ЗГТ в периоперативный период, вероятно, не повышает риски венозной тромбоэмболии во время и
после операции. (в) Смешанные результаты по влиянию феминизирующей ЗГТ на здоровье костей. Подавление андрогенов без замещения эстрогенами однозначно снижает минеральную плотность костей как среди взрослых, так и подростков.
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