Gender-Affirming Hormone Therapy and Risk of Inflammatory Bowel Disease Flare in Transgender and Gender Diverse Adults.

The overall incidence of IBD flare did not significantly increase in the year after GAHT initiation compared to the year before.

• 85 transgender and gender diverse adults with IBD who initiated GAHT were included across 5 IBD centers.
• In the year before GAHT, 42 (49%) flared compared with 32 (38%) in the year after.
• The difference was not statistically significant (P = 0.06).
• Flare was defined as need for steroids, IBD-associated emergency department visit, or need for IBD medication change.

Individuals with active IBD at the time of GAHT initiation were significantly more likely to flare in the year after starting GAHT.

• In univariate analysis, 58% of those with active IBD at GAHT initiation flared vs 24% without active IBD (P = 0.003).
• In multivariable logistic regression controlling for age and IBD type, the adjusted odds ratio was 5.1 (95% confidence interval 1.7–15.2).
• This association was significant in both univariate and multivariable analyses.

Individuals who received testosterone were more likely to experience an IBD flare in the year after starting GAHT compared to those who received estrogen.

• 51% of testosterone recipients flared vs 26% of estrogen recipients in the year after GAHT initiation (P = 0.02).
• The adjusted odds ratio for flare with testosterone use was 3.1 (95% confidence interval 1.2–8.1) in multivariable analysis.
• This association was significant in both univariate and multivariable analyses.
• 46 (54.1%) participants received estrogen and 39 (45.9%) received testosterone.

There was no statistically significant difference in incidence of IBD flare by age, IBD type, or IBD therapy type.

• Univariate analysis and multivariable logistic regression were used to assess factors associated with IBD flare.
• Models controlled for age and IBD type.
• Neither age, IBD type, nor IBD therapy type were significantly associated with flare risk.

The study population consisted of 85 transgender and gender diverse adults with IBD initiating GAHT, recruited retrospectively from 5 IBD centers.

• 46 (54.1%) received estrogen-based GAHT and 39 (45.9%) received testosterone-based GAHT.
• The study design was retrospective across 5 IBD centers.
• The primary aim was to evaluate the incidence of IBD flare in the year before and after GAHT initiation.