Endocrine Abstracts

Background: Recent studies have demonstrated an increased risk of cardiovascular disease in transgender adults compared to the cisgender population. It remains uncertain whether this increased risk is due to hormonal treatment or if individuals with gender dysphoria inherently have a higher baseline risk for cardio-metabolic complications. Within the UK, until recently, following confirmation of diagnosis according to WPATH criteria, gonadotropin-releasing hormone analogues (GnRHa) could be prescribed in these adolescents if there were signs of puberty. 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 were searched 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 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. Seven studies (47%) provided data on baseline characteristics and ten studies (67%) provided data on the impact of GnRHa. There was a total of 3865 adolescents with gender dysphoria and 81006 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. The evidence available for body composition, blood pressure and metabolic markers was limited and/or conflicting, both at baseline and following GnRHa treatment. Quality assessment identified twelve moderate quality and three low quality studies.

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