Endocrine regulation of cardiac repolarization: early QTc shortening after testosterone in healthy AFAB adults
Abstract
Testosterone modulates ventricular repolarization, yet the early time course of its effects in humans remains unclear. We conducted a prospective, single-center study in 10 healthy adults assigned female at birth initiating gender-affirming hormone therapy with daily transdermal testosterone gel. Standard 12-lead ECGs at baseline and 3 months showed no change in uncorrected QT, but significant QTc shortening by Bazett (-32 ms; P = .002) and Fridericia (-14 ms; P = .010) formulas, despite a concurrent heart rate reduction and with no association to changes in serum testosterone. These findings demonstrate rapid ventricular repolarization remodeling after testosterone initiation, with a magnitude comparable to the sex-based QTc gap. This study contributes to the characterization of early electrophysiologic adaptation to androgens in a standardized clinical model, and may inform cardiovascular monitoring strategies during abrupt hormonal transitions.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 10 participants or records.
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