Should We Evaluate Cardiac Biomarkers Differently in Transgender Patients?

To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

1. You are a member of the healthcare team, caring for a couple comprising of a 25-year-old transgender woman and a 29-year-old cisgender man. The man presented with chest pain and palpitations to the emergency department 3 days ago and was evaluated with high-sensitivity cardiac troponin (hs-cTn). In general, how would his hs-cTn levels compare with those of a cisgender woman of the same age?
   They would be modestly higher
   They would be modestly lower
   They would be similar
   They would be lower if the man was underweight
2. The 25-year-old transgender woman has a history of viral myocarditis and is followed with serial measurements of NT-proBNP. She takes estrogen regularly. On the basis of the results of the current study by Greene and colleagues, what should the healthcare team consider regarding her NT-proBNP values?
   She should be assessed with a scale for normal applicable to cisgender men
   She should be assessed with a scale for normal applicable to cisgender women
   The chronic use of estrogen obviates the value of NT-proBNP
   The cutline for a high NT-proBNP level should be increased by 40%