Does hormone therapy raise risk of IBD flare in gender-diverse adults?

The risk of an inflammatory bowel disease (IBD) flare does not increase in the year after initiating gender-affirming hormone therapy (GAHT), but individuals with IBD prior to hormone start and those receiving testosterone have a higher likelihood of having an IBD flare, a study has shown.

Eighty-five transgender and gender-diverse adults with IBD who initiated GAHT participated in this retrospective study conducted across five IBD centres. The authors assessed factors associated with IBD flare through univariate analysis and multivariable logistic regression controlling for age and IBD type.

Flare was defined as the need for steroids, IBD-related visits to the emergency department, or need for IBD medication change.

Of the participants, 46 (54.1 percent) received oestrogen and 39 (45.9 percent) received testosterone. Forty-two individuals flared in the year prior to GAHT compared with 32 in the year after (49 percent vs 38 percent; p=0.06). No statistically significant difference was noted in the incidence of flare by age, IBD type, or IBD therapy type.

Notably, individuals with active IBD at GAHT initiation were more likely to develop flares in both univariate (58 percent vs 24 percent; p=0.003) and multivariate analyses (adjusted odds ratio [aOR], 5.1, 95 percent confidence interval [CI], 1.7‒5.2).

Similarly, those who received testosterone had a higher likelihood of developing flares in the year after GAHT initiation (51 percent vs 26 percent; p=0.02; aOR, 3.1, 95 percent CI, 1.2‒8.1).