S1987 Therapeutic Trends and Flare Incidence in Transgender and Gender Non-Conforming Patients With Inflammatory Bowel Disease Undergoing Hormone Replacement Therapy

Introduction: The effect of hormone replacement therapy (HRT) on inflammatory bowel disease (IBD) in transgender and gender non-conforming (TGNC) patients remains unknown. IBD, including ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic autoimmune disorder with significant morbidity. Understanding the unique challenges and risks faced by TGNC patients, particularly those undergoing HRT, is essential for optimizing care. This study explores therapeutic differences and changes in flare incidence in TGNC patients with and without HRT. Based on data from cisgender patients, we hypothesize that HRT would reduce flares. Methods: We conducted a retrospective review of TGNC IBD patients from the Johns Hopkins Health System between January 2015 and October 2024. International Classification of Diseases codes were used to identify IBD patients with gender dysphoria. Patients were grouped by HRT status for comparison. Flares were classified as significant episodes requiring clinic, ED, or inpatient care, steroids, or adjustment in IBD therapy for new/increased IBD symptoms. Results: Twenty-eight patients were included, 23 on HRT, 5 not. HRT patients trended older at 31.3 years (CI 10.11) vs 24.2 years (6.53), P = 0.09. UC and CD rates were similar. Surprisingly, both groups were mostly transmen. Treatment patterns were comparable, with most patients on maintenance therapy and no trends in histologic differences. Three HRT patients had discontinued IBD therapy due to remission compared to 1 without HRT. The non-HRT group averaged 1.6 (2.07) flares compared to 0.52 (0.79) pre-HRT and 0.61 (0.94) post, P = 0.06 and 0.1. 8 in the HRT group reported no flares in either period. The combined flare mean in HRT patients was 1.13 (1.32), P = .52. Adjusting for disease duration and years before/on HRT narrowed group differences. Conclusion: We observed a trend toward fewer flares in HRT patients; however, the small sample size and duration limit conclusions. While IBD rates are equal in cis men and women, most patients were transmen, despite transwomen having 2-3 times greater prevalence in the general population, possibly reflecting genetic factors for inflammation. The observed age discrepancy may reflect greater opportunity for older patients to initiate HRT. These findings highlight the importance of tailored, inclusive IBD care, vigilant monitoring, and support for further investigation of disease trajectories in the young and expanding TGNC population.