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Cross-sex Hormone Therapy and Neuronal Plasticity

Primary Purpose

Gender Dysphoria

Status
Unknown status
Phase
Not Applicable
Locations
Brazil
Study Type
Interventional
Intervention
Estradiol
Sponsored by
Hospital de Clinicas de Porto Alegre
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gender Dysphoria focused on measuring Estradiol;, Brain, glutamate, spectroscopy, hypogonadism

Eligibility Criteria

18 Years - 60 Years (Adult)MaleAccepts Healthy Volunteers

Inclusion Criteria:

  • Transgender women
  • Age 18 to 60 years old.

Exclusion Criteria:

  • Use of psychostimulant drugs
  • Use of Antidepressive, Mood Stabiliser, Anti-psychotic, Benzodiazepines, anti-convulsivants, Anorexigenic
  • Endocrinological disease (other than diabetes)
  • Arterial Hypertensive Disease of Diabetes Mellitus out of control target
  • Neurological disease, including stroke or recent cranial trauma with loss or consciousness
  • HIV with low CD4 or high viral charge or symptomatic AIDS
  • Neoplasia

Sites / Locations

  • Hospital de Clínicas de Porto AlegreRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Transgender Women

Arm Description

Transgender women who already completed GAS or that agreed to start gonadotropin release hormone analogue to suppress endogenous sex hormones. If the participants were using CSHT in the moment of the study assignment, they were asked to stop hormones for 30 days to evaluate the impact of hypogonadism in the brain. After this first assessment, they received prescriptions for Estradiol (equine conjugated oestrogen, or estradiol valerate, or topic 17-beta estradiol formulations) for 60 days, and the impact of CSHT was evaluated again to compare to washout condition.

Outcomes

Primary Outcome Measures

Glutamate concentration in the left hippocampus
Proton Spectroscopy - magnetic resonance imaging; Glutamate concentration in the left hippocampus will be primarily correlated to working memory scores.

Secondary Outcome Measures

Cortical Thickness
Anatomical magnetic resonance imaging
Diffusion track imaging
Micro-Structural magnetic resonance imaging
functional connectivity
functional magnetic resonance imaging
Glutamate concentration in the anterior cingulate cortex and left dorsolateral prefrontal cortex
Proton spectroscopy - magnetic resonance imaging; Glutamate concentration in the left dorsolateral prefrontal cortex will be correlated to over all measures of cognition and executive functioning.
Cognition
Instrument: Wechsler Adult Intelligence Scale (WAIS) version 3. Subscale: Full Scale Intelligence coefficient. Mean: 100 Standard deviation (SD):15 for Brazilian population. Range of classification: 69 and below - Extremely Low 70-79 - Borderline 80-89 - Low Average 90-109 - Average 110-119 - High Average 120-129 - Superior 130 and above - very superior
Operational memory
Subscale from Wechsler Adult Intelligence Scale (WAIS) version 3. Mean: 100 Standard deviation (SD):15 for Brazilian population. 69 and below - Extremely Low 70-79 - Borderline 80-89 - Low Average 90-109 - Average 110-119 - High Average 120-129 - Superior 130 and above - very superior
Verbal memory
Rey Auditory-Verbal Learning Test (RAVLT). Mean and range for Brazilian population: A1 (Verbal Memory - Immediate recall). Range (in Z-scores): Z <-1.5 are classified as deficit; Z >-1.5 are expected A5 (Verbal Memory - immediate recall). Range (in Z-scores): Z <-1.5 are classified as deficit; Z >-1.5 are expected A7 (Verbal Memory - late recall). Range in (Z-scores): Z <-1.5 are classified as deficit; Z >-1.5 are expected Learning Over Trial (LOT) (Learning capacity). Range (in Z-scores): Z <-1.5 are classified as deficit; Z >-1.5 are expected (please, note the reference for Brazilian population in the section "references" where the mean and standard deviation according to Brazilian population are described for each of the subtest; Salgado et al. (2011).
Language (Verbal Fluency)
Verbal Fluency Tests: (FAS) and Animals. Mean and standard deviation (SD) according to age range and years of education: Age range for the test: 16-59 years Score classification according to years of education: From 0 to 8 years of education: Mean: 38.8 SD: 12.0 From 9 to 12 years of education: Mean: 40.5 SD: 10.7 From 12 to 21 years of education: Mean: 44.7 SD:11.2 Range in Z-scores: Z <-1.5 are classified as deficit; Z >-1.5 are expected
Executive function
Stroop Test -Victoria Version. Mean and standard deviation (SD) according to the age range and years of education: For 19-39 years old + 5-8 years of education: Mean: 33.3 SD:11.35 For 19-39 years old + 9 or more years of education: Mean: 41.73 SD: 9.85 For 40-59 years old + 5-8 years of education: Mean: 28 SD: 7.76 For 40-59 years old + 9 or more years of education: Mean: 37.17 SD: 9.98 Range in Z-scores: Z <-1.5 are classified as deficit; Z >-1.5 are expected

Full Information

First Posted
August 24, 2018
Last Updated
August 27, 2018
Sponsor
Hospital de Clinicas de Porto Alegre
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1. Study Identification

Unique Protocol Identification Number
NCT03651427
Brief Title
Cross-sex Hormone Therapy and Neuronal Plasticity
Official Title
Neuroactive Sex Steroids And Their Influence In Glutamatergic Neurotransmission - Effects in Memory and Cognition in Transgender People
Study Type
Interventional

2. Study Status

Record Verification Date
August 2018
Overall Recruitment Status
Unknown status
Study Start Date
February 13, 2017 (Actual)
Primary Completion Date
March 30, 2019 (Anticipated)
Study Completion Date
March 30, 2019 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hospital de Clinicas de Porto Alegre

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Transgender women (male-to-female) were invited to participate in this study to test the impact of Cross-Sex Hormone Therapy (CSHT) in the brain. Neuroimaging and cognitive assessment were performed in different time-points to compare the impact of CSHT in the brain.
Detailed Description
Sex hormones are known to exert several effect on the brain white matter, cerebral cortex, functional connectivity and neurotransmission. Furthermore, in transgender people, CSHT is know to induce anatomical and functional changes in the brain. However, only a few studies have already been conducted to investigate the effects of sex hormones on the brain accounting for the interference of endogenous gonadal hormones. Also, there is a lack of knowledge about the importance of CSHT after Gender Affirming Surgery (GAS) regarding induced hypogonadism that follows this surgical procedure. Therefore, neuroimaging studies designed to isolate the effect of endogenous gonadal hormones in people with GD urge to be developed. To fulfil this purpose, transgender women that have already performed GAS and/or were under Gonadotrophin Release Hormone analogues treatment (in order to induce hypogonadism similar to GAS) were invited to interrupt CSHT for at least 30 days to promote sex hormones washout. At the end of the washout, participants performed magnetic resonance imaging, laboratorial analyses for sex hormones and neuro-cognitive assessment. After this first time-point, participants received a new prescription for CSHT containing estradiol (without progesterone) to be used continuously for 60 days, when the same assessments from the end of washout were repeated 60 days after CSHT to compare brain and cognitive longitudinal changes. At all the time-points, variations in depression scores and anxiety levels were assessed with specific scales.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gender Dysphoria
Keywords
Estradiol;, Brain, glutamate, spectroscopy, hypogonadism

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Sel-controlled case series
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Transgender Women
Arm Type
Experimental
Arm Description
Transgender women who already completed GAS or that agreed to start gonadotropin release hormone analogue to suppress endogenous sex hormones. If the participants were using CSHT in the moment of the study assignment, they were asked to stop hormones for 30 days to evaluate the impact of hypogonadism in the brain. After this first assessment, they received prescriptions for Estradiol (equine conjugated oestrogen, or estradiol valerate, or topic 17-beta estradiol formulations) for 60 days, and the impact of CSHT was evaluated again to compare to washout condition.
Intervention Type
Drug
Intervention Name(s)
Estradiol
Other Intervention Name(s)
Drug washout
Intervention Description
Induced hypogonadism and re-institution of CSHT
Primary Outcome Measure Information:
Title
Glutamate concentration in the left hippocampus
Description
Proton Spectroscopy - magnetic resonance imaging; Glutamate concentration in the left hippocampus will be primarily correlated to working memory scores.
Time Frame
90 days
Secondary Outcome Measure Information:
Title
Cortical Thickness
Description
Anatomical magnetic resonance imaging
Time Frame
90 days
Title
Diffusion track imaging
Description
Micro-Structural magnetic resonance imaging
Time Frame
90 days
Title
functional connectivity
Description
functional magnetic resonance imaging
Time Frame
90 days
Title
Glutamate concentration in the anterior cingulate cortex and left dorsolateral prefrontal cortex
Description
Proton spectroscopy - magnetic resonance imaging; Glutamate concentration in the left dorsolateral prefrontal cortex will be correlated to over all measures of cognition and executive functioning.
Time Frame
90 days
Title
Cognition
Description
Instrument: Wechsler Adult Intelligence Scale (WAIS) version 3. Subscale: Full Scale Intelligence coefficient. Mean: 100 Standard deviation (SD):15 for Brazilian population. Range of classification: 69 and below - Extremely Low 70-79 - Borderline 80-89 - Low Average 90-109 - Average 110-119 - High Average 120-129 - Superior 130 and above - very superior
Time Frame
90 days
Title
Operational memory
Description
Subscale from Wechsler Adult Intelligence Scale (WAIS) version 3. Mean: 100 Standard deviation (SD):15 for Brazilian population. 69 and below - Extremely Low 70-79 - Borderline 80-89 - Low Average 90-109 - Average 110-119 - High Average 120-129 - Superior 130 and above - very superior
Time Frame
90 days
Title
Verbal memory
Description
Rey Auditory-Verbal Learning Test (RAVLT). Mean and range for Brazilian population: A1 (Verbal Memory - Immediate recall). Range (in Z-scores): Z <-1.5 are classified as deficit; Z >-1.5 are expected A5 (Verbal Memory - immediate recall). Range (in Z-scores): Z <-1.5 are classified as deficit; Z >-1.5 are expected A7 (Verbal Memory - late recall). Range in (Z-scores): Z <-1.5 are classified as deficit; Z >-1.5 are expected Learning Over Trial (LOT) (Learning capacity). Range (in Z-scores): Z <-1.5 are classified as deficit; Z >-1.5 are expected (please, note the reference for Brazilian population in the section "references" where the mean and standard deviation according to Brazilian population are described for each of the subtest; Salgado et al. (2011).
Time Frame
90 days
Title
Language (Verbal Fluency)
Description
Verbal Fluency Tests: (FAS) and Animals. Mean and standard deviation (SD) according to age range and years of education: Age range for the test: 16-59 years Score classification according to years of education: From 0 to 8 years of education: Mean: 38.8 SD: 12.0 From 9 to 12 years of education: Mean: 40.5 SD: 10.7 From 12 to 21 years of education: Mean: 44.7 SD:11.2 Range in Z-scores: Z <-1.5 are classified as deficit; Z >-1.5 are expected
Time Frame
90 days
Title
Executive function
Description
Stroop Test -Victoria Version. Mean and standard deviation (SD) according to the age range and years of education: For 19-39 years old + 5-8 years of education: Mean: 33.3 SD:11.35 For 19-39 years old + 9 or more years of education: Mean: 41.73 SD: 9.85 For 40-59 years old + 5-8 years of education: Mean: 28 SD: 7.76 For 40-59 years old + 9 or more years of education: Mean: 37.17 SD: 9.98 Range in Z-scores: Z <-1.5 are classified as deficit; Z >-1.5 are expected
Time Frame
90 days

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Transgender women Age 18 to 60 years old. Exclusion Criteria: Use of psychostimulant drugs Use of Antidepressive, Mood Stabiliser, Anti-psychotic, Benzodiazepines, anti-convulsivants, Anorexigenic Endocrinological disease (other than diabetes) Arterial Hypertensive Disease of Diabetes Mellitus out of control target Neurological disease, including stroke or recent cranial trauma with loss or consciousness HIV with low CD4 or high viral charge or symptomatic AIDS Neoplasia
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Maiko Schneider, MD
Phone
5551997722606
Email
maikoschneider@hcpa.edu.br
First Name & Middle Initial & Last Name or Official Title & Degree
Fernanda Rohrsetzer
Phone
51999614503
Email
fcunegatto@hcpa.edu.br
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Maria Lobato, Dr
Organizational Affiliation
Hospital de Clínicas de Porto Alegre
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital de Clínicas de Porto Alegre
City
Porto Alegre
State/Province
Rio Grande Do Sul
ZIP/Postal Code
90035-903
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Maiko Schneider, MD
Phone
5551997722606
Email
maikoschneider@hcpa.edu.br

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
21971775
Citation
Salgado JV, Malloy-Diniz LF, Abrantes SS, Moreira L, Schlottfeldt CG, Guimaraes W, Freitas DM, Oliveira J, Fuentes D. Applicability of the Rey auditory-verbal learning test to an adult sample in Brazil. Braz J Psychiatry. 2011 Sep;33(3):234-7. doi: 10.1590/s1516-44462011005000007.
Results Reference
result
Links:
URL
http://dx.doi.org/10.1590/S1516-44462011005000007
Description
This references is related to the "verbal memory" evaluation, described in the outcomes.

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Cross-sex Hormone Therapy and Neuronal Plasticity

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