Gender-affirming hormone treatment causes changes in gender phenotype in a 12-lead electrocardiogram

Heart Rhythm. 2021 Jul;18(7):1203-1209. doi: 10.1016/j.hrthm.2021.03.009. Epub 2021 Mar 8.

Abstract

Background: Men and women have specific patterns in an electrocardiogram (ECG) differentiated by J-point elevation and ST-segment angle. Although gender-affirming hormone treatment is one of the treatments for gender dysphoria, its influence on an ECG has not been clarified yet.

Objective: The purpose of this study was to investigate ECG changes induced by gender-affirming hormone treatment.

Methods: The study population consisted of 29 transgender males and 8 transgender females and 37 age- and sex-matched cisgender females and males. Male pattern was defined as J-point elevation > 0.1 mV and ST-segment angle > 20° in precordial leads.

Results: In the comparison between 29 transgender males and cisgender females, the prevalence of the male pattern (89.7% vs 6.9%; P < .001), prevalence of the early repolarization pattern (51.7% vs 17.2%; P = .01), J-point elevation (leads V1-V6), T-wave amplitudes (leads V1-V6), QRS amplitudes (leads II, III, V1-V6), and P-wave amplitudes (leads V1-V3) were significantly higher in transgender males. The prevalence of the male pattern was lower in transgender females than in cisgender males (25.0% vs 87.5%; P = .04). In the analysis of transgender males for whom ECGs were available before and after gender-affirming hormone treatment (n = 13), J-point elevation and T-wave amplitudes significantly increased after gender-affirming hormone treatment, leading to a higher prevalence of the male pattern (23.1% vs 92.3%; P < .001). The prevalence of the early repolarization pattern and QRS amplitudes also significantly increased after the treatment, but the augmentation of P-wave amplitudes was modest.

Conclusion: Gender-affirming hormone treatment for gender dysphoria is accompanied by a change in ECG phenotype toward affirming gender, in which change in androgen level may be involved.

Keywords: Early repolarization pattern; Electrocardiogram; Gender dysphoria; Gender-affirming hormone treatment; Sokolow-Lyon voltage.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Androgens / blood
  • Biomarkers / blood
  • Electrocardiography / methods*
  • Female
  • Follow-Up Studies
  • Gender Dysphoria / blood
  • Gender Dysphoria / drug therapy*
  • Gender Dysphoria / physiopathology
  • Hormones / therapeutic use*
  • Humans
  • Male
  • Phenotype
  • Retrospective Studies
  • Sex Factors
  • Transgender Persons*

Substances

  • Androgens
  • Biomarkers
  • Hormones