SUN-053 Evaluation of a 52-Year-Old Transgender Man During the First Year of Testosterone Therapy - Biochemical Changes, Body Composition and Cardiovascular Aspects at the Ergometric Test: A Case Report
Authors: Alvares Leonardo Azevedo Mobilia , Nakamoto Fernanda Patti , Pimenta Isabella Ferreira , Netto Luiza Travassos da Rosa , Ramos Henrique Afonso , boas Roberta Frota Villas , Bueno Thiago Limoli , Santos Lívia Marcela , Silva Frank Mobilia Alvares 
Published: May 2020

Abstract
Introduction: Testosterone (T) therapy is able to promote biochemical, body composition and cardiovascular (CV) changes in transgender men (TM). However, existing data concerns TM between 18 and 50 years old. Objective: To describe the first year of T therapy in a 52 yo TM - biochemical changes, body composition and CV aspects during exercise. Methods: Medical record review was accessed as well as laboratorial and image exams performed during the first year of T use. Results: TM, 52 yo, in perimenopause, normal weight, without chronic diseases, no previous usage of T, initiated testosterone undecanoate 1.000mg. A second dose was given 6 weeks after the first one and then every 12 weeks. Lab exams were collected on the day before the next shot of T. By the third month of treatment, it has been noted the highest level of T (586 ng/dL). Initial hemoglobin (Hb) was 13.0 g/dL and hematocrit (Ht) 37.1%. After 7 months of treatment they reached their highest levels, 16.3 g/dL (23%) and 47,1% (27%). LDLc increased from 106 to 139 mg/dL (31%) by the seventh month. HDLc dropped from 73 to 60 (- 13 mg/dL) by the seventh month. Initial bone mineral density (BMD) was normal and increased 3.1% in lumbar spine (L1-L4) and 2.7% in femoral neck after 1 year. The muscle mass (MM) increased 10.9% in one year. The ergometric test (ET) at the beginning of treatment showed an increase in systolic blood pressure (SBP) of 38.4% (130 to 180 mmHg) during exertion and a decrease of 27.7% in the third minute of passive recovery; as well as an increase in Heart Rate (HR) of 73 bpm during exertion and a reduction of 72 bpm at third minute of rest. One year after the use of T, SBP increased by 61.5% (130 to 210 mmHg), with a decrease of 52% and after three minutes of rest. HR increased 67 bpm during exertion and decreased by 75 bpm at the third minute of rest. Discussion: According to existing data the increase of Hb in young TM ranges from 4.9% to 12.5% and Ht from 4.4% to 17.6%, whereas in our case it varied 23% and 27%, respectively. The average HDLc drop between 3 and 24 months of T use is, respectively, -6,5 and -8,5 mg/dL, less than what is found in this report (-13 mg/dL). Cis women’s BMD decreases around 2% in lumbar spine, 1,4% in total hip and the MM shows reduction of 1lb 5,2oz during first year of climateric. Young cis women and men present an increase in SBP during ET around 34.0% and 39.8%, respectively, and in the third minute of recovery a drop around 20.6% and 23.4%. HR drops from 60.5 to 64.53 bpm in the third minute of rest and higher recoveries are associated with better parasympathetic reactivation and lower mortality. Conclusion: TM over 50 yo seems to present higher increase of Hb/HT and decrease of HDLc when compared to younger TM. The ET findings after 1 year of T might be a consequence of enlarged cardiac chambers, increased systolic volume and peripheral vascular resistance. TM who start T over 50 yo may need more careful CV screening.