Table 7.
Summary of the published studies evaluating changes in ALT and AST concentrations in relation to feminizing GAHT
| Reference | Data source | Age (y) | GAHT | ALT (IU/L)* | AST (IU/L)* | Analysis | Statistical test results |
|---|---|---|---|---|---|---|---|
| Wierckx et al, 201441 | Prospective evaluation of 53 patients from 2 sites of the European Network for the Investigation of Gender Incongruence (ENIGI): Ghent, Belgium and Oslo, Norway |
Ghent Mean: 32 SD: 15 Oslo Mean: 19 SD: 2 |
Oral estrogen EV 4 mg PO daily Estrogen patch 17-β estradiol: 100 μg/24 h |
Oral estrogen Baseline: 25 12 mo: 19 Estrogen patch Baseline: 30 12 mo: 21 |
Oral estrogen Baseline: 24 12 mo: 18 Estrogen patch Baseline: 27 12 mo: 20 |
Paired t-test or Wilcoxon test (not specified) |
Oral estrogen P = .01 for ALT P < .001 for AST Estrogen patch P = .12 for ALT P = .013 for AST |
| Jarin et al, 201731 | Chart review on 44 patients followed at 4 clinical centers in Washington, DC (2), Baltimore, MD and Cincinnati, OH | Mean: 18 Range: 14–25 |
Estradiol NOS: 1 −8 mg PO daily; 20 −80 mg IM monthly; or 0.025 −0.2 SQ weekly |
Baseline: 25.4 1−3 mo: 23.5 4–6 mo: 15.2 >6 mo: 17.3 |
Baseline: 20.1 1–3 mo: 24.9 4–6 mo: 19.6 >6 mo: 17.5 |
Repeated measures ANOVA |
P < .05 for ALT; at 4–6 mo and after 6 mo P > .05 for AST |
| Fernandez et al, 201732 | Chart review on 33 patients followed at a clinical center in Lexington, KY | Mean: 31 Range: 16–56 |
Estradiol NOS: PO 1.4–1.7 mg/d. or SQ or IM (dose NOS) |
Baseline: 27 3–6 mo: 28 6–18 mo: 24 |
Baseline: 23 3–6 mo: 22 6–18 mo: 23 |
Piared t-test for each follow up vs baseline | All P > .05 for ALT All P > .05 for AST |
| SoRelle et al, 201934 | Chart review on 87 GAHT naïve and 133 patients on GAHT from a county hospital and community clinic in Dallas, TX | Mean: 33 | Estradiol NOS: 2–8 mg PO daily; or EV 5–40 mg (93% subjects) |
Baseline: 21 >6 mo: 28 |
Baseline: 21 >6 mo: 19 |
Mann-Whitney test |
P < .005 for ALT P > .05 for AST |
*
Reported as a mean or median value, converted from SI units, if necessary.ALT = alanine aminotransferase; AST = aspartate aminotransferase; EV = estradiol valerate; GAHT = gender affirming hormone therapy; IM = intramuscular; IU/L = international units/liter; NOS = not otherwise specified; PO = per os (orally); SQ = subcutaneous.