Transgender Youth at Increased Risk of Dyslipidemia, Other Cardiometabolic Conditions

Data from an analysis presented at ENDO 2021 is offering endocrinologists and cardiovascular specialists an updated overview of the increased risk of conditions that adversely impact cardiometabolic health among transgender youth.

An analysis of data from more than 20,000 children, including more than 4000 with a diagnosis of gender dysphoria, results indicate transgender youth were at an increased risk of abnormal cholesterol, metabolic syndrome, obesity, and other conditions.

"This is the first study of its size in the United States of which we are aware that looks at the odds of youth with a diagnosis of gender dysphoria having medical diagnoses that relate to overall metabolic and cardiovascular health," said lead investigator Anna Valentine, MD, a pediatric endocrinology fellow at the University of Colorado Anschutz Medical Campus, in a statement.

With some estimates suggesting nearly 2% of all children in the US have gender dysphoria, developing a greater understanding of how gender-affirming hormone therapy impacts cardiometabolic health can improve and help identify gaps in care of these patients. With this in mind, a team from the University of Colorado Anschutz Medical Campus designed the current study with the aim of evaluating the difference in diagnoses of metabolic conditions and cardiometabolic risk in these patients versus matched cisgender controls.

Using the PEDSnet dates, which captures data from pediatric institutions across the US, investigators obtained data from 4,177 youth with a diagnosis of gender dysphoria treated at 6 sites between 2009-2019. Using data related to year of birth, age at last visit, site, race, ethnicity, insurance status, and duration in database, investigators identified 16,664 propensity-matched patients for their analysis.

Primary outcomes of interest for the analyses included odds of having a diagnosis of being overweight/obesity, hypertension, dyslipidemia, dysglycemia, liver dysfunction, polycystic ovary syndrome, or metabolic syndrome.

Of the 4,177 transgender youth identified for inclusion, 66% were female, 73% were White, 9% were Hispanic, and 61% had private insurance. IN comparison, the control group of cisgender youth was 67% female, 72% were white, 9% were Hispanic, and 61% had private insurance. Investigators noted average duration in the database (7 years) and age at last visit (16.2 years) were the same for both cohorts.

Upon analysis, investigators found transgender youth were 1.6 times more likely to have a diagnosis of dyslipidemia (OR, 1.6; 95% CI, 1.3-1.8; P <.0001) and 1.9 times more likely to have a diagnosis of a metabolic syndrome compared to cisgender youth (OR, 1.9; 95% CI, 1.2-3.0; P=.0086), with no significant difference based on sex. Among transgender youth with female sex, investigators noted a greater risk of being overweight/obese and for having a polycystic ovary syndrome diagnosis when compared to controls. Investigators pointed out there were no significant differences observed when assessing odds of having a diagnosis of hypertension, dysglycemia, or liver dysfunction when comparing transgender youth to cisgender controls.

"As research in pediatric transgender medicine is emerging, showing what medical conditions are being diagnosed more often in this population can help individuals, families and health care providers better manage their health," Valentine added.

This study, “Multicenter Analysis of Cardiometabolic-Related Diagnoses in Transgender Adolescents,” was presented virtually at ENDO 2021.