Distribution of High-Sensitivity Cardiac Troponin and N-Terminal Pro-Brain Natriuretic Peptide in Healthy Transgender People

IMPORTANCE Sex-specific differences in the commonly used cardiac biomarkers high-sensitivity cardiac troponin (hs-cTn) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are apparent. There is an absence of medical literature delineating the concentration differences for these biomarkers in transgender individuals without cardiac disease. OBJECTIVE To determine the distribution of hs-cTn and NT-proBNP in healthy transgender people. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional prospective study, healthy transgender individuals prescribed testosterone or estradiol for 12 months or more were recruited from internal medicine and primary care clinics that specialize in transgender medical care between November 1, 2017, and July 1, 2018. EXPOSURES Testosterone or estradiol for 12 months. MAIN OUTCOMES AND MEASURES Concentrations for hs-cTnI (troponin I), hs-cTnT (troponin T), and NT-proBNP were measured. RESULTS Transgender people prescribed testosterone (n = 79; mean [SD] age, 28.8 [7.8] years) or estrogen (n = 93; mean [SD] age, 35.1 [11.7] years) were recruited. The concentration of hs-cTn was significantly higher in transgender men relative to transgender women. For Abbott hs-cTnl levels, the median (IQR) concentration observed in transgender men and women was 0.9 (0.6-1.7) ng/L and 0.6 (0.3-1.0) ng/L, respectively. Results were similar across 2 additional hs-cTn assays. In contrast, NT-proBNP level was higher in transgender women. The median (IQR) NT-proBNP concentration was significantly higher in transgender women (49 [32-86] ng/L) than in transgender men (17 [13-27] ng/L). CONCLUSIONS AND RELEVANCE Findings of this cross-sectional study suggest that the differences in concentration for hs-cTn and NT-proBNP between transgender men and women were similar to what is observed between cisgender men and women. Sex hormones, rather than sex assigned at birth, may be a stronger driver of the observed concentration differences between healthy men and women for biomarkers of cardiac disease. (C) 2022 American Medical Association. All rights reserved.

Automated summary

This study aims to explore the concentration differences of two cardiac biomarkers in transgender individuals without cardiac disease. The results show that transgender men have significantly higher hs-cTn levels compared to transgender women, while NT-proBNP levels are significantly higher in transgender women. These findings suggest that sex hormones may be the main driving factor of concentration differences in cardiac disease biomarkers between healthy men and women.