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Cirrhosis is chronic, progressive end-stage liver disease that occurs when scar tissue prevents the liver from functioning normally. Studies have shown that two of the leading causes of cirrhosis — alcohol use disorder and viral hepatitis — occur more frequently in transgender individuals, but there has been little research examining if these risk factors translate into greater incidences of cirrhosis among transgender patients.
A new study from Keck Medicine of USC published in The American Journal of Gastroenterology finds that transgender adults have double the prevalence of cirrhosis compared to cisgender adults (people whose gender identity matches the sex they were assigned at birth), suggesting a need for more supportive, preventive care.
“Our study reveals that cirrhosis disproportionately affects transgender individuals and highlights a pressing health issue that needs addressing,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine and principal investigator of the study.
Lee and his colleagues launched the study to provide scientifically backed liver health guidance for physicians so they could offer transgender patients a higher level of care.
Besides discovering that transgender cirrhosis rates are double that of the cisgender population, the study authors also learned that the majority of transgender adults with cirrhosis (60%) have a diagnosis of anxiety and/or depression, compared to 40% of the cisgender patients with cirrhosis.
They also found that alcohol was the leading cause of cirrhosis in the transgender group, accounting for some 60% of cases while the percentage of cisgender adults with alcohol-associated cirrhosis was approximately 50%.
In other findings, transgender patients with cirrhosis also tended to be younger (a larger portion were 44 or younger), had higher rates of viral hepatitis and were five times more likely to have HIV/AIDS than their cisgender counterparts.
Possible reasons behind the disparity
Lee hypothesizes that the increased rates of depression and anxiety may be driving higher rates of alcohol use among transgender patients, which in turn, may result in greater cases of cirrhosis.
The increased rate of HIV/AIDS among transgender patients may also be a factor in that both conditions are known to be associated with liver disease progression, according to Lee.
Lack of access to quality health care could also play a role, hypothesizes Jeffrey Kahn, MD, a hepatologist and liver transplant physician with Keck Medicine and co-author of the study.
Researchers also studied the five-year outcomes among all transgender and cisgender patients with cirrhosis. Interestingly, despite the differences in the two groups, the number of possible negative outcomes of cirrhosis — liver failure, liver transplant and liver cancer, as well as death, by any cause — was the same.
“This finding suggests that the transgender community is underserved in the initial stages of liver disease, but individuals are able to secure the care they need once cirrhosis is diagnosed,” said Kahn. “Early prevention is key because if liver disease is caught in time, there is less of a chance it will progress to cirrhosis.”
To reach their conclusions, study authors culled data from a large national database, Optum Clinformatics® Data Mart Database (Optum), that contained medical claims for more than 60 million patients covered by commercial insurance or Medicare between the years of 2007-2022. They first identified all transgender and cisgender adults, and then compared the incidences of cirrhosis among each group as well as causes of the disease. Additionally, researchers tracked depression and anxiety in patients.
Lee and Kahn hope the study will spur more research and motivate health care practitioners to provide transgender patients with extra support, including liver screenings and access to mental health resources. “This population requires specific attention from clinicians and researchers alike,” said Lee.
Keck Medicine efforts to support transgender patient wellness
Keck Medicine launched the USC Gender-Affirming Care Program to provide tailored, supportive health care to the transgender population. The program provides a full range of expert, compassionate health care services for the transgender, non-binary and gender-diverse community, including everything from routine health care, such as preventive cancer screenings, yearly checkups and flu shots, to gender-affirming hormone therapy and surgery.
The program is comprised of physicians from several disciplines, including family medicine, plastic surgery, gynecology, urology and otolaryngology. Specialists in voice, occupational and physical therapy are also available to patients.
Additionally, Keck Medicine hospitals have been awarded the ‘LGBTQ+ Healthcare Equality Leader’ designation in the Human Rights Campaign Foundation’s 2024 Healthcare Equality Index (HEI) for seven times in recent years. HEI is the leading national benchmarking survey of health care facility policies and practices dedicated to the equitable treatment and inclusion of LGBTQ+ patients, visitors and employees.