Title : Gallbladder disease in transgender individuals: Associations with gender-affirming hormone therapy
Abstract:
Significance:Gender-Affirming Hormone Therapy (GAHT) plays a vital role in gender identity affirmation for transgender individuals. While hormonal profiles after GAHT may differ from cisgender individuals, the impact of GAHT on gallbladder disease risk in transgender populations hasn't been studied. This is the first paper to study gallstone disease risk in the transgender population and assess the relationship between GAHT and changes in GD risk.
Methods:The study analyzed medical records data from the TrinetX database from 52,847 trans men and 38,114 trans women. Four cohorts were created: trans women on estrogen GAHT or no intervention (TWHT, TWNI), and trans men on testosterone therapy or no intervention (TMHT, TMNI). Descriptive statistics were calculated before matching to estimate disease burden. The groups were then propensity score matched on known risk factors and rates of GD were compared.
Results:Before matching, the 10-year probability of GD was 4.69% for TWHT versus 1.88% for TWNI. Among trans men, the 10-year rates were 3.15% for TMHT and 3.87% for TMNI. The 10-year cholecystectomy rates were higher for TWHT compared to TWNI (1.10% vs. 0.57%), but TMHT had a lower rate at 10 years than TMNI (0.95% vs. 1.10%).
After matching to account for differences in underlying risk factors, TWHT had a higher risk of GD (HR 1.832, 95%CI: 1.324, 2.533). In contrast, TMHT showed no significant difference in GD risk (HR 0.844, 0.95%CI: 0.645, 1.103).
Conclusion:This study suggests a link between estrogen GAHT and increased GD risk in transgender women. Notably, testosterone GAHT did not offer protection against GD in transgender men, contrary to expectations. This study is the first to describe the burden of GD in transgender patients and to investigate the effects of cross-sex hormone administration on GD risk. Future research should investigate best practices for screening and early intervention.
Audience Take Away:
- This study is the first to investigate the link between gender-affirming hormone therapy and cholelithiasis in transgender patients.
- The research will inform clinical practice, allowing for a greater understanding of biliary risk factors when treating transgender patients.
- Will provide helpful background and guidance about special concerns for patients receiving gender-affirming therapy.
