Research shows cirrhosis affects twice as many transgender adults as cisgender adults

Cirrhosis is a 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 abuse and viral hepatitis, are more common in transgender people, but little research has been done on whether these risk factors lead to a higher incidence of cirrhosis in transgender people.

A new study from Keck Medicine of USC published in The American Journal of Gastroenterology concludes that cirrhosis is twice as common in transgender people as in cisgender people (people whose gender identity matches the sex they were assigned at birth). This suggests a need for more supportive, preventive care.

“Our study shows that cirrhosis disproportionately affects transgender people and highlights an urgent health problem that must be addressed,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist at Keck Medicine and principal investigator of the study.

Lee and his colleagues launched the study to provide physicians with evidence-based guidelines for liver health, so they can provide better care to transgender patients.

The study authors not only found that cirrhosis rates among transgender people are twice as high as those among cisgender people, but also found that the majority of transgender people with cirrhosis (60%) have a diagnosis of anxiety and/or depression, compared to 40% of cisgender people with cirrhosis.

They also found that alcohol was the leading cause of cirrhosis in the transgender group, accounting for about 60% of cases, while the percentage of cisgender adults with alcohol-related cirrhosis was about 50%.

Other findings showed that transgender patients with cirrhosis tended to be younger (a higher proportion were 44 years or younger), had a higher risk of viral hepatitis, and were five times more likely to have HIV/AIDS than their cisgender counterparts.

Possible reasons behind the difference

Lee hypothesizes that increased rates of depression and anxiety may lead to higher alcohol use among transgender patients, which in turn may lead to more cases of cirrhosis.

According to Lee, the increased incidence of HIV/AIDS among transgender patients may also play a role, as both conditions are linked to the progression of liver disease.

Lack of access to quality health care could also play a role, suspects Jeffrey Kahn, a hepatologist and liver transplant physician at Keck Medicine and co-author of the study.

Researchers also looked at five-year outcomes among all transgender and cisgender patients with cirrhosis. Interestingly, the number of possible negative outcomes of cirrhosis (liver failure, liver transplantation, and liver cancer, as well as death from any cause) was the same, despite the differences in the two groups.

“This finding suggests that the transgender community is underserved in the early stages of liver disease, but individuals can receive the care they need once cirrhosis is diagnosed,” Kahn said. “Early prevention is key because if liver disease is detected early, it is less likely to progress to cirrhosis.”

To reach their conclusions, the study authors gathered data from a large national database, Optum Clinformatics Data Mart Database (Optum), which contains medical claims from more than 60 million patients covered by commercial insurance or Medicare between the years 2007-2022. They first identified all transgender and cisgender adults and then compared the incidence of cirrhosis in each group, as well as the causes of the disease. Researchers also tracked depression and anxiety in patients.

Lee and Kahn hope the study will spur more research and motivate health care providers to provide additional support to transgender patients, including liver screenings and access to mental health services. “This population requires specific attention from both clinicians and researchers,” Lee said.