Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients

<b><i>Purpose:</i></b> Sex differences in cardiac arrhythmias are well established. This study aimed to explore the prevalence of arrhythmias in transgender and nonbinary (TGNB) adults. <b><i>Methods:</i></b> This cross-sectional study utilized electronic medical records from a center specializing in TGNB care. Adults aged <i>≥</i>18 years with <i>≥</i>2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups: TGNB (transgender men, transgender women, nonbinary [NB]-assigned male at birth, NB-assigned female at birth), cisgender men, and cisgender women. The primary outcome was any arrhythmia using age- and race-adjusted regression models comparing transgender patients with cisgender men and cisgender women. Prevalence of arrhythmias was explored in transgender people with a gender-affirming hormone therapy (GAHT) prescription. <b><i>Results:</i></b> The sample included 49,862 adults, with 7121 (14%) TGNB persons. Median age was 28 years. Prevalence of arrhythmias was low (0.7-1.4% NB persons, 1.4-1.5% transgender persons). After adjustment, transgender women and transgender men had similar odds of any arrhythmia compared with cisgender men (transgender women: adjusted odds ratio [aOR] 0.89, 95% confidence interval [CI] 0.63-1.24, <i>p</i> = 0.52; transgender men: aOR 1.17, 95% CI 0.82-1.62, <i>p</i> = 0.37), but higher odds of any arrhythmia compared with cisgender women (transgender women: aOR 1.65, 95% CI 1.13-2.34, <i>p</i> = 0.01; transgender men: aOR 2.15, 95% CI 1.48-3.04, <i>p</i> < 0.001). Prevalence of arrhythmias appeared similar among transgender adults regardless of GAHT use (transgender men: 1.5% vs 1.9%, transgender women: 1.2% vs 2.1%). <b><i>Conclusion:</i></b> Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.