Endocrine Abstracts

Introduction: According to the DSM-5, gender dysphoria (GD) is defined as a distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. This condition may require gender-affirming hormone therapy (GAHT), in order to reduce distress. GAHT, however, is not free from side effects and it could increase the risk of onset of new pathological conditions.

Aim of the study: To evaluate cardiovascular comorbidities and events in a cohort of patients with GD taking GAHT.

Subjects and methods: We enrolled subjects with GD [assigned male at birth (AMAB) and assigned female at birth (AFAB)] who were regularly followed by the local gender team in Molinette Hospital, Turin (Italy), between February 2007 and July 2021. For each patient, at each access anthropometric parameters, smoking habit and a cardiovascular assessment (arterial hypertension, diabetes, dyslipidaemia, ACS, stroke, DVT) were recorded. A baseline analysis of the whole cohort was carried out; subsequently an evaluation of cumulative incidence of comorbidities during GAHT was performed. Finally, mortality was assessed in terms of SMR (standardized mortality ratio - ratio between observed and expected death).

Results: We enrolled 613 patients, 380 transgender-AMAB with a median age of 33.9 years [22.04-45.85] and 233 transgender-AFAB, aged 27.4 years old [22.01-39.54], observed for a median follow-up time of 43.50 [17-72.25] and 41.50 [19-74] months, respectively. Only transgender-AMAB showed a significant weight gain (+2 Kg after 24 months). At baseline, 39% of transgender-AMAB and 39.1% of transgender-AFAB were active smokers; no significant difference during follow-up was recorded. During observation time, new cases of arterial hypertension (n=12), diabetes (n=4) and dyslipidaemia (n=28) were recorded in transgender-AMAB, while 12 new cases of arterial hypertension, 2 of diabetes and 21 of dyslipidaemia were reported in transgender-AFAB. Three cases of DVT were registered within transgender-AMAB. One case of ACS and one stroke were described in transgender-AFAB group. Finally, 4 deaths were recorded in the transgender-AMAB group (1.04%) and 1 in the transgender-AFAB group (0.42%). In both groups, SMR was higher than age-matched cisgender women [AMAB SMR: 1.32 (IC 95% 0.42-3.19); AFAB SMR: 1.26 (IC 95% 0.04-3.91)].

Conclusions: Although transgender-AFAB and AMAB enrolled were relatively young and not fully representative of the general transgender population, during GAHT an increase of main cardiovascular comorbidities was observed. Thus, our data highlight the need of a proper follow-up and medical monitoring to manage these new conditions and to prevent the onset of major cardiovascular events.