Clinical Course of Transgender Adolescents with Complicated Postural Orthostatic Tachycardia Syndrome Undergoing Hormonal Therapy in Gender Transition: A Case Series.

Jeffrey R. Boris,Thomas Bernadzikowski,Zachary B.R. McClain

doi:10.1089/trgh.2019.0041

Abstract

Purpose: Postural orthostatic tachycardia syndrome (POTS), an increasingly recognized dysautonomia, may affect as many as 3,000,000 Americans. Concurrently, prevalence estimates suggest 10% of individuals identify as lesbian, gay, bisexual, transgender, or questioning/queer. The preponderance of female POTS patients implies hormonal differences between natal sexes and their role in POTS. Transgender POTS patients using hormone therapies may offer further insight into the mechanism of POTS. There have been no previously published studies of transgender patients with POTS undergoing gender-affirming hormone therapy.Methods: We reviewed our electronic health record for clinical histories of transgender patients in our POTS Database.Results: Three patients who transitioned from female to male demonstrated clinical improvement of their POTS symptoms with the addition of testosterone therapy.Conclusion: We present our clinical experience of three transgender POTS patients who transitioned from female to male with hormone therapy, all of whom demonstrated clinical improvement with testosterone. This may give further insight into the pathophysiology of POTS. However, the authors do not endorse the use of hormone therapy as primary therapy for the symptoms of POTS.

Highlights

Postural orthostatic tachycardia syndrome (POTS), a dysautonomia that is increasingly being recognized and diagnosed, is thought to affect as many as 3,000,000 people in the United States.[1,2] At the Children’s Hospital of Philadelphia (CHOP) alone, nearly 950 pediatric patients through age 18 years were diagnosed from 2007 to 2018
Caring for LGBTQ youth is a part of every general pediatric practice,[6] and gender diverse and transgender adolescents may be of particular interest within this group of patients with POTS
There are data suggesting various triggers, such as infection and concussion,[4] a high incidence of associated joint hypermobility,[4,11,12] that autoantibodies are increasingly being found in association with POTS patients,[13,14] and that natal females are more affected than natal males.[15,16]

Summary

Introduction

Postural orthostatic tachycardia syndrome (POTS), a dysautonomia that is increasingly being recognized and diagnosed, is thought to affect as many as 3,000,000 people in the United States.[1,2] At the Children’s Hospital of Philadelphia (CHOP) alone, nearly 950 pediatric patients through age 18 years were diagnosed from 2007 to 2018. Cases Patient 1 is a natal female identifying as male (uses he/ him/his pronouns) who was diagnosed with POTS in November 2014 at age 16 years.

Results

Conclusion