Transgender-Affirming Hormone Therapies, QT Prolongation, and Cardiac Repolarization
Authors' conclusion
In this cohort study, testosterone use in transgender men was associated with QTc and QTp shortening and increased TAmp. Androgen deprivation in transgender women was associated with opposite observations. The magnitude of QTc sexual dimorphism seen in cisgender adults was also observed in the transgender population. This work highlights that potential GAHT effects on cardiac repolarization warrant attention in the exponentially increasing transgender population, which is often exposed to coprescribed drugs prolonging QTc and at risk of TdP.
Study context
- Population
- Adult transgender individuals, single center in France, 2021–2023; mean age 29.7 years; 64 transgender men, 56 transgender women
- Participants
- 120 individuals
- Exposure
- Transgender individuals receiving GAHT vs before GAHT
- Transgender women receiving GAHTn = 35
- Transgender men before GAHTn = 23
- Transgender men receiving GAHTn = 41
- Transgender women before GAHTn = 21
- Outcome
- ECG features: QTc, T-wave maximal amplitude (TAmp), QT peak (QTp)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Transgender women receiving GAHT vs Transgender men receiving GAHT: P < 0.001 · Transgender women receiving GAHT vs Transgender women before GAHT: P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | Mean change (milliseconds) | P value |
|---|---|---|
| QTc change after start of GAHT, transgender women (n=15)After GAHT vs Before GAHT · SD 12; increased QTc | 20 | P < 0.001 |
| QTc change after start of GAHT, transgender men (n=18)After GAHT vs Before GAHT · SD 16; decreased QTc | −17 | P < 0.001 |
Hormone associations with QTc (nonlinear mixed models)
- Transgender men: total testosterone, mean (SD) estimate −1.6 (0.6) ms/ng/mL
- P = 0.007
- Transgender men: prolactin, mean (SD) 0.4 (0.1) ms/ng/mL
- P < 0.001
- Transgender women: total testosterone, mean (SD) estimate −3.5 (0.8) ms/ng/mL
- P < 0.001
QT peak (QTp) and TAmp
- Variation of QTp and TAmp after GAHT start globally associated with QTc changes, in opposite directions for transgender women and men
Safety
QTc >480 ms or QTc change >60 ms after start of GAHT
- Participants with QTc >480 ms or QTc change >60 ms
- 0
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →