Multicenter Analysis of Cardiometabolic-Related Diagnoses in Transgender and Gender Diverse Youth: a PEDSnet study.

2022

08/2022

1945-7197

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

OBJECTIVE: 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).

DESIGN: 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.

SETTING: Six PEDSnet sites.

PATIENTS OR OTHER PARTICIPANTS: TGDY (n=4,172) were extracted from PEDSnet and propensity-score matched on 8 variables to controls (n=16,648).

INTERVENTION(S): N/A.

MAIN OUTCOME MEASURE(S): 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% confidence interval 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 [1.3-2.3], 3.7 [2.1-6.7], respectively) and liver dysfunction (1.5 [1.1-1.9], 2.5 [1.4-4.3]) than TGDY not prescribed GAHT. TGDY with a testosterone prescription alone had higher odds of overweight/obesity (1.8 [1.5-2.1]) and hypertension (1.6 [1.2-2.2]) than those not prescribed testosterone. Estradiol and GnRHa alone were not associated with greater odds of cardiometabolic-related diagnoses.

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

10.1210/clinem/dgac469

J Clin Endocrinol Metab

35945152

Behavioral Health Diagnoses in Youth With Gender Dysphoria Compared with Controls: A PEDSnet Study.

2021

2021 Sep 24

1097-6833

<p><strong>OBJECTIVE: </strong>To assess the odds of a psychiatric or neurodevelopmental diagnosis among youth with a diagnosis of gender dysphoria compared with matched controls in a large electronic health record dataset from six pediatric health systems, PEDSnet. We hypothesized that youth with gender dysphoria would have higher odds of having psychiatric and neurodevelopmental diagnoses than controls.</p>

<p><strong>STUDY DESIGN: </strong>All youth with a diagnosis of gender dysphoria (n=4,173 age at last visit 16.2 + 3.4) and at least one outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables to controls without gender dysphoria (n=16,648, age at last visit 16.2 + 4.8) using multivariable logistic regression. The odds of having psychiatric and neurodevelopmental diagnoses were examined using generalized estimating equations.</p>

<p><strong>RESULTS: </strong>Youth with gender dysphoria had higher odds of psychiatric (OR: 4.0 [95% CI: 3.8, 4.3] P &lt; .0001) and neurodevelopmental diagnoses (1.9 [1.7, 2.0], p&lt;0.0001). Youth with gender dysphoria were more likely to have a diagnosis across all psychiatric disorder sub-categories, with particularly high odds of mood disorder (7.3 [6.8, 7.9], p&lt;0.0001) and anxiety (5.5 [5.1, 5.9], p&lt;0.0001). Youth with gender dysphoria had a greater odds of autism spectrum disorder (2.6, [2.2, 3.0], p&lt;0.0001).</p>

<p><strong>CONCLUSIONS: </strong>Youth with gender dysphoria at large pediatric health systems have greater odds of psychiatric and several neurodevelopmental diagnoses compared with youth without gender dysphoria. Further studies are needed to evaluate changes in mental health over time with access to gender affirming care.</p>

10.1016/j.jpeds.2021.09.032

J Pediatr

34571022