Inflammatory Bowel Disease Outcomes in Transgender and Gender Nonconforming Patients Receiving Gender-Affirming Hormone Therapy
Background:
Little is known about IBD outcomes in transgender and gender nonconforming (TGNC) patients receiving gender-affirming hormone (GAH) therapy. The aim of this study was to compare IBD outcomes in the year before and after GAH initiation.
Methods:
This was an IRB-approved, retrospective, multicenter study across 5 tertiary care IBD centers. Adult TGNC IBD patients were identified through the electronic medical record by use of demographic data (including self-reported gender identity, where available) and ICD-10 diagnoses. Records were reviewed for clinical characteristics, medication use, colonoscopy results, and lab results including CRP and fecal calprotectin (FC) in the year before and after GAH initiation. Statistical analysis was done with Wilcoxon Rank Sum testing.
Results:
Eighty-five TGNC IBD patients who received GAH therapy were included in this study. Forty-seven patients (55%) had Crohn’s disease and 38 (45%) had ulcerative colitis (UC). Of the patients with Crohn’s disease, 29 (62%) had ileocolonic disease, 17 (36%) had perianal disease, 15 (32%) had penetrating disease, and 20 (43%) had stricturing disease. Of the 38 patients with UC, 32 (84%) had pancolitis. Twenty-eight patients (33%) had a prior IBD-related surgery. Forty-two patients (49%) were transgender women, 28 (33%) were transgender men, and 15 (18%) were gender non-binary. Forty-six patients (54%) received GAH therapy with estrogen and 39 (46%) received GAH therapy with testosterone. Median age at hormone start was 23.5 years (range 16-60). At time of hormone start, 50 patients (59%) were on a biologic or small molecule. In the year after starting hormones, 19 patients (22%) required a change in their IBD therapy: 4 started a biologic, 3 required dose escalation of their biologic, 11 required changing biologics, and 1 required adding an immunomodulator. There was no significant difference in CRP or FC in the year before and after GAH start. Median CRP in the year prior to GAH start was 3 mg/L (IQR 1–11.7 mg/L, n=42) completed 90 days prior to hormone start (IQR 30–270 days). Median CRP in the year after GAH start was 3 mg/L (IQR 1–8.6 mg/L, n=39) completed 113 days after hormone start (IQR 45–258 days), <italic>P-</italic>value 0.77. Median FC in the year prior to GAH start was 113µg/L (IQR 31–425µg/L, n=20) completed 128 days prior to GAH start (IQR 49–193 days). Median FC in the year after GAH start was 293 µg/L (IQR 88–1190µg/L, n=18) completed 140 days after hormone start (IQR 61–326 days), <italic>P-</italic>value 0.16. 31 patients had a colonoscopy in the year prior to GAH start and 29 patients had a colonoscopy in the year after GAH start. Fourteen patients had a colonoscopy completed both in the year before and after GAH initiation and only 2/14 (14%) had worsening of inflammation in the year after starting hormones.
Conclusions:
Overall, this multicenter study found no significant difference in disease activity, as measured by CRP, FC, and endoscopic evaluation in the year after starting GAH therapy in TGNC IBD patients.
