Multicenter Analysis of Cardiometabolic-related Diagnoses in Transgender and Gender-Diverse Youth: A PEDSnet Study

Abstract

Context: Studies on cardiometabolic health in transgender and gender-diverse youth (TGDY) are limited to small cohorts.

Objective: This work aimed to determine the odds of cardiometabolic-related diagnoses in TGDY compared to matched controls in a cross-sectional analysis, using a large, multisite database (PEDSnet).

Methods: Electronic health record data (2009-2019) were used to determine odds of cardiometabolic-related outcomes based on diagnosis, anthropometric, and laboratory data using logistic regression among TGDY youth vs controls. The association of gender-affirming hormone therapy (GAHT) with these outcomes was examined separately among TGDY. TGDY (n = 4172) were extracted from 6 PEDSnet sites and propensity-score matched on 8 variables to controls (n = 16 648). Main outcomes measures included odds of having cardiometabolic-related diagnoses among TGDY compared to matched controls, and among TGDY prescribed GAHT compared to those not prescribed GAHT.

Results: In adjusted analyses, TGDY had higher odds of overweight/obesity (1.2; 95% CI, 1.1-1.3) than controls. TGDY with a testosterone prescription alone or in combination with a gonadotropin-releasing hormone agonist (GnRHa) had higher odds of dyslipidemia (1.7; 95% CI, 1.3-2.3 and 3.7; 95% CI, 2.1-6.7, respectively) and liver dysfunction (1.5; 95% CI, 1.1-1.9 and 2.5; 95% CI, 1.4-4.3) than TGDY not prescribed GAHT. TGDY with a testosterone prescription alone had higher odds of overweight/obesity (1.8; 95% CI, 1.5-2.1) and hypertension (1.6 95% CI, 1.2-2.2) than those not prescribed testosterone. Estradiol and GnRHa alone were not associated with greater odds of cardiometabolic-related diagnoses.

Conclusion: TGDY have increased odds of overweight/obesity compared to matched controls. Screening and tailored weight management, sensitive to the needs of TGDY, are needed.

Keywords: body mass index; cardiometabolic; cholesterol; gender dysphoria; hormone therapy; pediatric.

Figure 1.

Odds of cardiometabolic-related diagnoses among TGDY vs controls. The forest plots show the odds ratios and 95% CIs of cardiometabolic-related diagnoses among TGDY compared to controls. Higher odds ratios (> 1) indicate that TGDY are more likely to have the listed diagnosis. Lower odds ratios (< 1) indicate that TGDY are less likely to have the listed diagnosis. Unadjusted analyses are shown in gray squares; adjusted analyses (for overweight/obesity, depression, and antipsychotic medication use) are shown in black circles. Overweight/obesity and PCOS not adjusted for overweight/obesity. *P < .01. PCOS, polycystic ovary syndrome; TGDY, transgender and gender-diverse youth.

Figure 2.

Odds of cardiometabolic outcomes by prescription among transgender and gender-diverse youth. The forest plots show the adjusted odds ratios and 95% CIs of cardiometabolic health outcomes among TGDY prescribed these medications compared to those not prescribed these medications. Higher odds ratios (> 1) indicate that TGDY prescribed these medications are more likely to have the listed diagnosis compared to TGDY not prescribed these medications. Lower odds ratios (< 1) indicate that TGDY on these medications are less likely to have the listed diagnosis compared to TGDY not on these medications. *P < .01, **P < .001, ***P < .0001. TGDY, transgender and gender-diverse youth.