Background/Purpose: Minimal medical research exists regarding transgender patients, particularly within the field of rheumatology. A few case reports note that male to female transitions may precede presentation of autoimmune disease, with a possible link to exogenous estrogen, while exogenous testosterone was noted to improve a case of subacute cutaneous lupus. There is currently no research assessing transgender demographics and disease presentation in the rheumatologic setting.

Methods: We conducted a retrospective chart review of transgender patients who presented to our academic and community clinics or inpatient rheumatology service. We collected information on patients’ medical history and rheumatologic diagnoses, transition (legal, social and medical), presenting symptoms and treatment.

Results: From 25 rheumatologists contacted, 12 transgender patients were identified. Patients’ ages ranged from 22-66 years old and had the following diagnoses: PsA, seronegative SpA, PM with SSc overlap, SSc, PMR, FM, leucocytoclastic vasculitis, periodic fever syndrome and osteopenia. Five (42%) patients had uncontrolled disease or relapse of their disease requiring adjustment of their treatment regimens. The most common co-morbidity was depression and anxiety (n=7, 58% patients). A family history of autoimmune disease was documented in 5 (42%) patients. Nine (75%) of patients were transgender males, 8 of whom were using intramuscular testosterone and 2 of whom had hysterectomies with bilateral salpingoopherectomies. Only 3/9 transgender male patients had a documented start time of testosterone therapy. However, 7 patients had either been on testosterone at diagnosis or were on it for at least 1 year before being diagnosed with their rheumatologic conditions. Of 3 transgender females, 2 were exposed to estrogen therapy prior to presentation. One patient had only a one-time use of exogenous estrogen and significant silica exposure for >20 years that was her major risk factor for developing systemic sclerosis.

Conclusion: The majority of patients presenting in our rheumatology clinics and inpatient service were transgender males undergoing transition. These data correlate with prior research that most rheumatologic diseases have a higher prevalence for biologic females. However, of the diseases with female prevalence in our study (PM, PMR, SSc, osteopenia and FM), almost half the patients diagnosed were biologically male (3/7). We believe larger studies need to be done to assess whether hormone transitions, either via gonadectomy and/or with exogenous hormones, can affect the prevalence of these diseases in transgender patients. In addition, we recommend rheumatologists carefully document when medical transitions occur relative to their rheumatologic condition in order to track timing of new diagnoses or changes in their disease. Additionally, given the high prevalence of depression seen in our study, we recommend that physicians pay particular attention to the mental health of their transgender patients at each follow-up and direct them to supports as needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/transgender-patients-in-the-rheumatology-setting/