No increased risk for IBD flare 1 year after gender-affirming hormone therapy
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Key takeaways:
- Researchers reported no overall risk for IBD flare in the year after gender-affirming hormone initiation.
- Patients with active IBD and those who received testosterone were more likely to experience a flare.
PHILADELPHIA — Although there was no overall increased risk for flare 1 year after gender-affirming hormone therapy in patients with inflammatory bowel disease, active IBD and receiving testosterone increased the likelihood of a flare.
“Prior studies have shown there’s a similar prevalence of IBD in the cisgender and transgender patient populations, but little is known about IBD outcomes in transgender and gender nonconforming patients or the impact of gender-affirming hormone therapy on IBD,” Audrey L. Bennett, MD, assistant professor of medicine in the division of gastroenterology, hepatology and nutrition at Vanderbilt University Medical Center, said at the ACG Annual Scientific Meeting.
“Prior hormone studies that have been done in IBD patients have primarily been completed in cisgender patients, for example, estrogen replacement therapy in peri- and postmenopausal cisgender women and the treatment of low testosterone in cisgender men.”
To evaluate the rate of IBD flare following gender-affirming hormone therapy initiation among transgender and gender nonconforming patients, Bennett and colleagues conducted a retrospective study using data from five tertiary care IBD centers.
They included 85 patients (mean age, 23.5 years; 95% white), of whom 49% identified as transgender women, 33% as transgender men and 18% as gender nonbinary. In terms of hormone type and IBD status at hormone initiation, 54% received estrogen, 46% received testosterone and 39% had active IBD. The split was fairly even between Crohn’s disease and ulcerative colitis (55% vs. 45%).
The researchers compared rates of flare in the year before and the year after hormone initiation and defined flare as a new steroid prescription and/or an IBD-associated ED visit and/or the need for IBD medication change.
Results showed 49% of patients experienced a flare in the year prior to hormone initiation compared with 38% in the year following hormone initiation — a difference that was not statistically significant. There also was no significant difference in the rate of flare by age (< 30 years: 42% vs. 30 years: 30%), IBD type (CD: 45% vs. UC: 30%) or use of advanced therapy (no: 34% vs. yes: 40%).
However, patients with active IBD at hormone initiation were more likely to experience a flare in the following year (58% vs. 24%; P = .003), as were those who received testosterone vs. estrogen (53% vs. 26%; P = .01). Results were similar in multivariate analysis (OR = 5.1; 95% CI 1.7-15.2 and OR = 3.1; 95% CI, 1.2-8.1, respectively).
“There is no overall increased risk of flare in the year after starting gender-affirming hormone therapy, but that patients who have active IBD at the time of starting hormones are five times more likely to experience a flare ... and patients who received testosterone as compared to estrogen are three times more likely to experience a flare,” Bennett said.
She added, “I think it’s crucial that we understand the potential impact of gender-affirming hormone therapy on IBD outcomes, so we can help physicians and patients provide and receive informed care.”
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Bennett A, et al. Impact of gender-affirming hormone therapy in transgender and gender non-conforming patients with inflammatory bowel disease. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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