Cardiopulmonary Exercise Testing in Transgender and Gender-Diverse Patients

Gustavo A. Cortes-Puentes MD , Thomas G. Allison PhD, MPH , Caroline J. Davidge-Pitts MBBCh , Cesar A. Gonzalez PhD, LP , Amanda R. Bonikowske PhD , Kaiser G. Lim MD , Cassie C. Kennedy MD
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Abstract

Background

Sex assigned at birth is currently used to calculate predicted normative values for oxygen consumption during cardiopulmonary exercise testing (CPET) in transgender and gender-diverse (TGD) patients. It is unclear if this is physiologically valid once gender-affirming hormonal therapy (GAHT) has been instituted.

Research Question

What are the changes in functional aerobic capacity (FAC) and % predicted peak oxygen consumption (V˙o2peak) when gender is used, instead of sex assigned at birth (SAB), to estimated normative predicted values among TGD patients aged > 14 years who are receiving GAHT?

Study Design and Methods

We retrospectively analyzed 16 referred TGD patients (eight transgender men and eight transgender women) receiving GAHT at the time of the test. Data collected and analyzed included the following: clinical indication for CPET, biometrics (age, height, and weight), CPET parameters (treadmill, Mayo Clinic protocol, without chest binder), chest imaging, echocardiographic results, and hemoglobin levels.

Results

In transgender women, the use of gender congruent normative predictive values, instead of SAB, significantly increased FAC (mean ± SE for SAB and gender, respectively, 69.70% ± 4.35% vs 87.82% ± 5.15%; P ≤ .0001) and % predicted Vo2peak (mean ± SE for SAB and gender, respectively, 66.53% ± 4.17% vs 89.69% ± 5.60%; P ≤ .0001). In transgender men, the use of gender congruent normative predictive values showed that both FAC and % predicted Vo2peak significantly decreased (approximately 20% and 25%, respectively). Deconditioning was the most frequent CPET finding among transgender men.

Interpretation

Among TGD individuals receiving GAHT, the use of gender to calculate normative values affects % predicted peak exercise oxygen consumption and FAC significantly. Body composition changes after GAHT require regular monitoring of muscle strength, lean body mass, and aerobic capacity. Cardiopulmonary symptoms among TGD patients should be assessed with these variables in mind, especially in the presence of chronic cardiac and pulmonary diseases.

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变性和性别差异患者的心肺运动测试:性别对预测有氧运动能力的影响
背景目前,变性和性别多元化(TGD)患者在进行心肺运动测试(CPET)时,出生时的性别分配被用于计算耗氧量的预测标准值。研究问题当使用性别而不是出生时性别分配(SAB)来估算接受 GAHT 治疗的 14 岁 TGD 患者的正常预测值时,他们的有氧功能容量(FAC)和预测峰值耗氧量百分比(V˙o2peak)会发生哪些变化?研究设计与方法我们回顾性分析了 16 名转诊的 TGD 患者(8 名变性男性和 8 名变性女性)在接受 GAHT 测试时的情况。收集和分析的数据包括:CPET 的临床指征、生物统计学指标(年龄、身高和体重)、CPET 参数(跑步机、梅奥诊所方案,无胸部束缚器)、胸部成像、超声心动图结果和血红蛋白水平。结果在变性女性中,使用与性别一致的常模预测值而不是 SAB 可显著增加 FAC(SAB 和性别的平均值±SE 分别为 69.70% ± 4.35% vs 87.82% ± 5.15%;P ≤ .0001)和预测 Vo2peak%(SAB 和性别的平均值±SE 分别为 66.53% ± 4.17% vs 89.69% ± 5.60%;P ≤ .0001)。在变性男性中,使用性别一致的常模预测值显示,FAC 和预测 Vo2peak 百分比均显著下降(分别约为 20% 和 25%)。在接受 GAHT 治疗的 TGD 患者中,使用性别来计算标准值对预测峰值运动耗氧量和 FAC 的影响很大。接受 GAHT 治疗后身体成分发生变化,需要定期监测肌肉力量、瘦体重和有氧能力。在评估 TGD 患者的心肺症状时应考虑到这些变量,尤其是在患有慢性心肺疾病的情况下。
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