Clinical Trial: The Relation of GnRH Treatment to QTc Interval in Transgender Females

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Observational

Official Title: The Relation of GnRH Treatment to QTc Interval in Transgender Female Youth: A Time Series Study

Brief Summary:

Background: The QT interval of the electrocardiogram (ECG), corrected for heart rate (QTc), is a measure of the duration of ventricular repolarization and is a widely used marker of ventricular arrhythmia risk. Testosterone has a shortening effect on QTc length, and the QTc interval in males is shorter than in females after the onset of puberty. Transgender female adolescents are treated with GnRH agonists or spironolactone that suppress endogenous testosterone secretion and might increase the QT interval sufficiently to increase the risk for malignant ventricular arrhythmias. There are no current guidelines regarding monitoring QTc interval in transgender females undergoing GnRH agonist treatment.

Objective: To assess the effect of GnRH agonist treatment on QTc interval in transfemale youth.

Methods: A quasi-experimental time series study of transgender female adolescent, seen at UCSF Child and Adolescent Gender Center (CAGC) during 2017-2019.

Specific aims:

To assess the impact of GnRH agonist treatment on QTc interval length in transgender female adolescent


Detailed Summary:

This study is a quasi-experimental time series study, designed to examine the relation between GnRH agonist treatment for 6 months in transgender female youth and electrocardiographic change in QTc interval. Study subjects will be identified when visiting the UCSF Child and Adolescent Gender Center (CAGC). A baseline electrocardiogram (ECG) will be obtained in clinic before initiation of GnRH agonist treatment and at the 6 months follow up appointment.

Sampling scheme: Consecutive sample of transfemale patients presenting to UCSF CAGC (Child and Adolescent Gender Center) clinics meeting entry criteria, who consent to participate in this study

Recruitment strategy: The investigators will approach all transfemale patients with pubertal Tanner stage 4-5 who are ready to start GnRH agonist. From past experience in CAGC clinic, willingness of patients to participate in studies is high. The investigators plan that ECG will be available at clinic visits to further assist recruitment.

Retention strategy: Patients that are being treated in CAGC clinic are followed up every 3 months. Patients are very compliant with clinic visits as patients are eager to complete their transition. ECG is planned to be available at the 6 months clinic follow up visit.

Measurements: The investigators will assess QTc interval using a standard 12-lead ECG. The investigators will also measure serum levels of calcium, potassium and magnesium to rule out electrolyte abnormalities as a cause for QTc interval change, and testosterone, estradiol, LH and FSH levels to assess GnRH agonist effect. The laboratory analytes will be measured using standard procedures in place at the UCSF Laboratory, which is certified by Centers for Medicare and Medicaid Services, the
Sponsor: University of California, San Francisco

Current Primary Outcome: change in QTc Interval [ Time Frame: 6 months ]

A 12-lead ECG will be performed using standardized inspected equipment, at baseline and after 6 months of treatment, difference in milliseconds will be calculates


Original Primary Outcome: Same as current

Current Secondary Outcome: QTc interval > 450 milliseconds [ Time Frame: 6 months ]

number of participants with QTc > 450 milliseconds at 6 months


Original Secondary Outcome: Same as current

Information By: University of California, San Francisco

Dates:
Date Received: February 28, 2017
Date Started: March 2017
Date Completion: January 2020
Last Updated: March 7, 2017
Last Verified: March 2017