Electrocardiographic changes in transgender patients on gender-affirming hormone replacement therapy.

QRS duration decreased significantly in transgender women following estrogen HRT.

• QRS duration decreased from a median of 96.0 (92.0–106.0) ms pre-HRT to 94.0 (86.0–100.0) ms post-HRT (p = 0.022).
• Study included 17 transgender women and 13 transgender men in a retrospective, single-institution cohort.
• This change trends toward the typically shorter QRS durations observed in cisgender women.
• Comparisons were made using paired t-tests and Wilcoxon signed-rank tests on pre- and post-HRT EKGs.

P-wave amplitude decreased in select precordial leads in transgender women following estrogen HRT.

• P-wave amplitude decreased in leads V3 (p = 0.024) and V4 (p = 0.037) post-HRT.
• This was observed among the 17 transgender women in the cohort.
• The finding reflects a trend toward electrocardiographic patterns of the affirmed gender.

R-wave amplitude decreased in lateral precordial leads in transgender women following estrogen HRT.

• R-wave amplitude decreased in leads V4 (p = 0.008), V5 (p = 0.025), and V6 (p = 0.011) post-HRT.
• This pattern of decreased R-wave amplitude in lateral leads trends toward patterns typically observed in cisgender women.
• Findings were based on the 17 transgender women in the cohort.

T-wave amplitude changes differed by direction between transgender women and transgender men in precordial leads.

• T-wave amplitude was lower in transgender women in lead V2 post-HRT (p = 0.016).
• T-wave amplitude was higher in transgender men in leads V2 (p = 0.015) and V3 (p = 0.024) post-HRT.
• These bidirectional changes trend toward the T-wave patterns of the respective affirmed gender.
• Transgender men were receiving testosterone HRT; transgender women were receiving estrogen HRT.

Heart rate increased significantly in Black transgender women following estrogen HRT.

• Heart rate increased from 71.6 ± 12.8 to 84.9 ± 19.2 beats per minute post-HRT (p = 0.015) in Black transgender women.
• This finding emerged from a race-stratified subgroup analysis.
• Similar differences in P-, R-, and T-wave amplitude were also observed in Black transgender patients in select precordial leads.
• The overall cohort comprised 30 patients, so the race-stratified subgroup was a subset of this.

The study population was small, consisting of 30 transgender patients with available pre- and post-HRT EKGs at a single institution.

• 17 transgender women and 13 transgender men met inclusion criteria.
• The study was retrospective and single-institution.
• Inclusion required available pre- and post-HRT EKGs along with demographic data.
• Authors noted that larger studies are needed to clarify structural and arrhythmogenic implications.

Baseline EKG differences between cisgender men and women informed the study's hypothesis regarding HRT-induced changes in transgender individuals.

• Cisgender men typically exhibit shorter QTc intervals, longer QRS durations, and longer PR intervals compared to cisgender women.
• Limited prior data described the effects of gender-affirming HRT on EKG parameters in transgender individuals.
• The study aimed to evaluate whether HRT-associated EKG changes trend toward the patterns of the affirmed gender.

The authors recommend standardizing baseline and follow-up EKGs when initiating gender-affirming HRT.

• The recommendation is based on the observed electrocardiographic changes associated with HRT.
• Authors suggest larger studies are needed to clarify structural and arrhythmogenic implications of these changes.
• The findings support clinical monitoring of EKG parameters in transgender patients beginning HRT.