Gender Minority Stress, Testosterone, and Blood Pressure Responses to Stress in Transgender and Nonbinary Adults

Trans and nonbinary adults assigned female at birth (TNBF) are at elevated cardiovascular risk, an effect proposed to occur secondary to testosterone use. However, gender minority (GM) stress may also contribute to cardiovascular risk. Therefore, we examined the relative association of GM stress and testosterone to blood pressure (BP) and its regulation in TNBF adults. In 24 TNBF adults (12 not using and 12 using testosterone), GM stress was derived from a standardized composite score of seven psychosocial scales, and total testosterone was measured via radioimmunoassay. BP was assessed at rest and during acute physical (cold pressor test; CPT) and psychological (stroop colour word test; SCWT) stress. Resting systolic (SBP; 115±7 vs 115±13mmHg; P=0.978) and diastolic BP (DBP; 68±6 vs 68±11mmHg; P=0.995) did not differ between testosterone non-users and users. Backward elimination linear regression indicated that GM stress was negatively associated (SBP: β: -0.589, P=0.002; DBP: β: -0.492, P=0.006) and total testosterone was positively associated (SBP: β: 0.301, P=0.079; DBP: β: 0.422, P=0.013) with BP responses to the SCWT (SBP: R²=0.430, P=0.003; DBP: R²=0.553, P=0.001), but not resting BP or BP responses to the CPT. Our findings suggest that greater GM stress exposure blunts BP responses to psychological, but not physical, stress, whereas higher total testosterone levels are associated with greater BP responses to psychological stress among TNBF adults. Given established links between BP, its regulation, and cardiovascular risk, these data highlight the importance of integrating both physiological and psychological factors when examining cardiovascular risk in TNBF adults.