Associations between transition-specific stress experience, nocturnal decline in ambulatory blood pressure, and C-reactive protein levels among transgender men.

OBJECTIVES To characterize challenges experienced during stages of female-to-male sex transition and investigate associations between transition-specific measures of psychosocial stress, nocturnal decline in ambulatory blood pressure (amBP), and changes in C-reactive protein (CRP) levels. METHODS For this biocultural study, 65 healthy transmen who were using testosterone (T) therapy participated in interviews to assess transition-specific stress experience. They provided perceived stress scores, self-esteem scores, 24-h amBP measures, salivary samples for T levels, and a blood spot for CRP levels. Psychosocial stress was examined in relation to amBP and CRP using linear regression while adjusting for age, body mass index, and smoking. RESULTS There were no differences in mean levels of amBP in association with stage of transition. Men reporting stress associated with being "out" as transgender had significantly diminished nocturnal decline in systolic and diastolic amBP compared to men who did not report such stress. The associations remained significant when examined among men in stages 1 and 2 (≤ 3 years on T), but not among men in stage 3 (>3 years on T) of transition. Men reporting stress related to "passing" as someone born male had higher CRP levels than those who did not report such stress. The association remained significant when examined among men in stages 2 and 3 (>0.5-3 years on T). CONCLUSION Measures of stress that captured individuals' experiences of gender liminality were associated with diminished nocturnal decline in amBP and increased levels of CRP. There are significant differences between men grouped into different stages of the transition process.