S2394 Metabolic Dysfunction-Associated Steatotic Liver Disease and Hormone Therapy for Gender-Affirming Care

Introduction: The prevalence of transgender and gender diverse individuals has increased over the last decade. The risk of developing metabolic dysfunction-associated steatotic liver disease in this group (MASLD) is unknown. We hypothesize that testosterone therapy is associated with increased risk of MASLD, estimated by change in alanine transaminase (ALT) serum level, in transgender and gender diverse patients who were assigned woman at birth. Methods: This retrospective review involved a subgroup analysis of a Gender Medicine Registry called DREAM (Duke Research for Equitable Access to Medicine). The population of interest included all transgender and gender diverse adults who were woman at birth seen in the Gender Medicine Clinic between January 1, 2018 to February 28, 2024 with at least 1 year follow up. Patients with known chronic liver diseases were excluded. The exposure variable was testosterone therapy, and the outcome of interest was ALT level evaluated at 2 time periods: initiation of testosterone therapy or first encounter date, and 1 year follow-up. Results: Two hundred seventeen patients were included in the final cohort, with an average age of 26.7 years (SD 8.8) and average body mass index of 30.3 kg/m2 (SD 8.5). 195 patients (89.9%) were started on testosterone on or after their first visit date. Regarding the outcome variable, 69% of the cohort did not have baseline or 1-year follow up labs recorded (90% of the non-exposed group, and 66% of the testosterone group). The mean change in ALT over 1 year follow-up for group that received testosterone was 4.64 U/L (SD 13.2). Statistical analyses comparing these differences are pending at time of abstract submission. Conclusion: This study evaluates the risk of developing liver disease after institution of testosterone therapy in a traditionally underrepresented population. At baseline, most patients in this cohort did not have an elevated ALT level indicative of low probability of intrinsic liver disease or liver fibrosis. More than 2-thirds of our cohort had missing data making it difficult to draw conclusions. This highlights the importance of performing regular liver enzyme tests with testosterone therapy, especially as patients age and have longer exposure to therapy. We recognize that short duration, young average age, and high percentage of missing data are major limitations of this study. Next steps for include performing individual chart reviews to look for missing laboratory data, and future studies with longer follow-up periods.