From the Guidelines
Delestrogen (estradiol valerate) injection does have a mild influence on liver enzymes in transgender women, with values shifting toward the affirmed gender 1. When considering the impact of Delestrogen on liver enzymes, it's essential to understand that the effect is generally less pronounced compared to oral estrogens, as the injectable form bypasses first-pass liver metabolism. However, some individuals may still experience mild elevations in liver enzymes, particularly if they have pre-existing liver conditions or are receiving high doses. Key points to consider include:
- The influence of gender-affirming hormone therapy (GAHT) on liver enzymes is well-documented, with studies showing that values shift toward the affirmed gender 1.
- Regular monitoring of liver function through blood tests is crucial, especially during the first year of hormone therapy, to promptly identify any significant elevations in liver enzymes.
- The dosage of Delestrogen can be adjusted based on individual response and blood levels, with typical ranges from 5-20mg intramuscularly every 1-2 weeks.
- If significant liver enzyme elevations occur, healthcare providers may consider reducing the dose or switching to transdermal estrogen formulations, which have an even lesser impact on the liver 1.
- The liver effects are dose-dependent, so maintaining the lowest effective dose that achieves desired feminization and adequate hormone levels is crucial to minimize potential liver issues.
From the Research
Delestrogen (Estradiol Valerate) Injection and Liver Enzymes in Transgender Women
- The effect of Delestrogen (estradiol valerate) injection on liver enzymes in transgender women is not directly addressed in the provided studies.
- However, studies have investigated the impact of hormone replacement therapy (HRT) on liver function in various populations, including women with Turner's syndrome 2, 3.
- A study on women with Turner's syndrome found that HRT with oestradiol valerate improved liver function, as evidenced by a significant fall in liver enzymes 2.
- Another study on women with Turner's syndrome found that HRT reduced liver enzymes, but had no effect on quantitative liver functions 3.
- The incidence of liver injury in transgender women using gender-affirming hormone therapy, including estradiol agents, is reported to be very low, at 0.1% and 0.0% according to female and male reference intervals, respectively 4.
- A review of liver function in transgender persons highlights the potential hepatotoxic effects of exogenous androgenic steroids, estradiol agents, and anti-androgens, but does not provide specific data on Delestrogen (estradiol valerate) injection 5.
- Studies on the effects of estrogen preparations on liver function tests have found little to no effect on liver function with the use of low-dose estrogen oral contraceptives 6.