Int J Transgend Health. 2025 May 20;27(2):1033-1044. doi: 10.1080/26895269.2025.2503219. eCollection 2026.
ABSTRACT
Background : Hormones play a significant role in modulating cardiac electrophysiology. Gonadotropin-releasing hormone agonists (GnRHa) and gender-affirming hormonal treatment (GAHT) may impact QTc intervals, which could have clinical implications.
AIM: To evaluate QTc interval changes in transgender/gender-diverse (TGD) adolescents undergoing GnRHa and GAHT.
METHODS: This prospective study included 39 TGD adolescents (20 females), mean age 15.6 ± 1.4 years, Tanner stage 4-5. QTc intervals were measured before and after GnRHa treatment and following GAHT initiation.
RESULTS: The mean QTc increased significantly from 382.4 ± 16.2 ms at baseline to 402.9 ± 20.1 ms after GnRHa treatment (p = .019) and remained prolonged at 402.8 ± 19.6 ms after estrogen addition (p = .988) in 10 TGD females, with an overall significant change across all treatment phases (p = .020). The mean QTc increased from 371.6 ± 15.4 ms to 380.8 ± 13.5 ms (p = .180) in 10 TGD females who initiated combined GnRHa and estrogen. Pooling both TGD female groups, mean QTc increased significantly from 377.0 ± 16.3 ms to 391.8 ± 19.9 ms after GnRHa and estrogen (p = .014). The mean QTc increased from 386.3 ± 15.5 ms at baseline to 398.8 ± 24.1 ms after GnRHa treatment (p = .178) and decreased significantly to 377.7 ± 18.1 ms after the addition of testosterone (p = .009) in 6 TGD males, with an overall significant change across all treatment phases (p = .010). The mean QTc decreased from 395 ± 20.3 ms to 385.2 ± 19.8 ms (p = .139) in 13-TGD males who initiated combined GnRHa and testosterone. Pooling both TGD male groups, mean QTc decreased significantly from 392.4 ± 19.0 ms to 382.8 ± 19.1 ms after GnRHa and testosterone (p = .044). Two participants, prescribed psychiatric medications exhibited a borderline/short QTc after adding testosterone. No arrhythmias were observed.
DISCUSSION AND CONCLUSION: QTc prolongation was observed in TGD female adolescents after the initiation of GnRHa, while TGD males showed a decrease in QTc following testosterone administration. Further studies on the clinical implications of QT interval changes in this population are warranted.
PMID:41891082 | PMC:PMC13015028 | DOI:10.1080/26895269.2025.2503219
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