Endocrine Abstracts

JOINT2323

Background: There is evidence of an increased risk of cardiovascular disease in transgender adults compared to the cisgender population. It is unclear whether this is secondary to hormonal treatment, or if individuals with gender dysphoria inherently have a higher baseline risk for cardiometabolic complications. Data on the safety and efficacy of gonadotrophin-releasing hormone analogues (GnRHa) is limited in adolescents with gender dysphoria.

Aim: This systematic review aims to assess the cardiometabolic status in treatment-naive adolescents with gender dysphoria and evaluate the impact of GnRHa on these outcomes.

Methods: Three databases (Embase, Medline and Cochrane Library) were searched to April 2024 for studies which evaluated cardiometabolic outcomes in adolescents with gender dysphoria <18 years and/or those who had had been treated with GnRHa. Quality assessment was performed by two independent reviewers using an adapted version of the Newcastle-Ottawa Scale for cohort studies in gender dysphoria. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines were used.

Results: Ten pre-post studies and five cross-sectional studies published between 2014 and 2023 fulfilled eligibility criteria. A narrative synthesis was performed. Quality assessment identified one high quality, twelve moderate quality and two low quality studies. Seven studies (47%) provided data on baseline characteristics and ten studies (67%) provided data on the impact of GnRHa. There was a total of 3772 adolescents with gender dysphoria along with 78792 age-matched cisgender controls. Multiple studies reported an increased prevalence of overweight and/or obesity or an increased BMI z-score in adolescents with gender dysphoria at baseline. There was no evidence of significant change in BMI following treatment for approximately one year. Limited and/or conflicting evidence was available in relation to body composition, blood pressure and metabolic markers at baseline and following GnRHa treatment.

Conclusion: This systematic review found an increased risk of excess weight in young people with gender dysphoria. There was no evidence of an increase in BMI with GnRHa treatment. Due to limited data, no definitive conclusions can be drawn about other cardiometabolic outcomes in adolescents with gender dysphoria, either at baseline or following pubertal suppression. Longitudinal prospective studies with standardized designs and key outcome measures are essential for advancing knowledge in this area.