Disease activity, as measured by C-reactive protein (CRP), foecal calprotectin (FC), and endoscopic evaluation, does not significantly vary a year following the initiation of gender-affirming hormone (GAH) therapy in transgender and gender nonconforming patients with inflammatory bowel disease (IBD), as shown in a study presented at AIBD 2024. 

“Overall, this ... study found no significant difference in disease activity ... in the year after starting GAH therapy in transgender and gender nonformingIBD patients,” according to the investigators led by Shravya Pothula from the University of Colorado, Aurora, Colorado, US. 

Pothula and her team conducted this retrospective, multicentre study across five tertiary care IBD centres and identified 85 adult transgender and gender nonconforming IBD patients through an electronic medical record by using demographic data and ICD-10 diagnoses. 

The investigators also reviewed the record for clinical characteristics, medication use, colonoscopy results, and laboratory results including CRP and FC in the year prior to and after GAH initiation. Finally, Wilcoxon Rank Sum testing was used to perform a statistical analysis. 

Of the eligible participants, 47 (55 percent) had Crohn’s disease and 38 (45 percent) had ulcerative colitis (UC). Among those with Crohn’s disease, 29 (62 percent) had ileocolonic disease, 17 (36 percent) had perianal disease, 15 (32 percent) had penetrating disease, and 20 (43 percent) had stricturing disease. In UC patients, the majority (n=32, 84 percent) had pancolitis. [AIBD 2024, abstract S16] 

Hormone therapy 

A third of the patients (n=28, 33 percent) had IBD-related surgery in the past. In addition, 42 (49 percent) participants were transgender women, 28 (33 percent) were transgender men, and 15 (18 percent) were nonbinary. Forty-six patients (54 percent) received GAH therapy with estrogen and 39 (46 percent) with testosterone. The median age at the start of hormone therapy was 23.5 years. 

At the start of GAH therapy, 50 patients (59 percent) were being treated with a biologic or small molecule. A year later, 19 patients (22 percent) needed to change their IBD therapy: four started a biologic, three required dose escalation of their biologic, 11 required changing biologics, and one had to add an immunomodulator. 

No significant difference was observedin either CRP or FC in the year before and after initiating GAH therapy. The median CRP in the year prior to GAH start was 3 mg/L (n=42) completed 90 days prior to hormone initiation, and the median CRP a year after was 3 mg/L (n=39) completed 113 days after hormone start (p=0.77). 

On the other hand, the median FC in the year prior to GAH start was 113 μg/L (n=20) completed 128 days before initiating GAH, and the median FC a year later was 293 μg/L (n=18) completed 140 days following hormone start (p=0.16). 

Furthermore, colonoscopy was performed in 31 patients in the year prior to GAH therapy and in 29 in the year after hormone initiation. Fourteen participants completed the procedure both in the year before and after GAH start, and only two of 14 (14 percent) experienced worsening of inflammation a year after starting hormone therapy.