Introduction
Current Endocrine Society guidelines recommend that transgender women taking spironolactone have their potassium levels checked every 3 months for the first year after initiating therapy and annually thereafter to monitor for hyperkalemia. The goal of this study was to assess the need for such frequent potassium monitoring and to investigate whether age plays a role in potassium abnormalities in transgender, gender diverse and non-binary (TGDNB) individuals taking spironolactone.
Methods
Using EPIC-Clarity, a retrospective study of healthy, adult individuals with gender identity disorder listed in their problem list and taking spironolactone was performed. We analyzed incidence of hyperkalemia in this population. Data from June 2006 through November 2021 were obtained. Exclusion criteria included: hypertension, renal failure, diabetes mellitus, heart failure and medications that affect the renin-angiotensin-aldosterone system.
Results
318 healthy TGDNB individuals met our inclusion criteria. We identified 8/318 (2.5%) individuals with hyperkalemia on spironolactone. There was a significant difference in incidence of hyperkalemia events in those age >45 years and those age ≤45 years old (8.9% vs. 1.5%, p= 0.016).
Conclusion
Our data suggest the incidence of hyperkalemia in our TGDNB population is low, particularly in those ≤45 years old; however, this risk increases with age. These findings suggest practice guidelines may need to be adjusted to minimize unnecessary testing in this population ≤45 years old who are not plagued by co-morbidities that affect potassium handling.
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