Testosterone use, minority stress, and pressor responses to mental stress in trans and non-binary adults assigned female sex at birth

Background: Trans and non-binary adults assigned female sex at birth (TNBF) present with higher blood pressure (BP), and thus greater cardiovascular disease risk, than cisgender adults, an effect proposed to occur secondary to testosterone use. However, chronic exposure to discrimination and resultant minority stress (MS) are associated with higher BP in other disinvested populations. Thus, we tested the hypothesis that both testosterone use and MS elevate resting BP in TNBF adults. As acute mental stress evoked by the Stroop Colour-Word Test (SCWT) can reveal BP dysfunction not apparent at rest, we also hypothesized that testosterone use and MS potentiate BP responses to SCWT in TNBF adults. Methods: TNBF adults without overt cardiovascular disease participated in the study (n=18, age: 25±6 [18-43] yr; body mass index [BMI]: 24±5 [16-37] kg/m 2 ). Minority stress: Quantified as a standardized composite score derived from seven scales capturing depression, anxiety, discrimination, gender dysphoria, benevolent childhood experiences, dissociative experiences, and resilience. A median split separated the cohort into higher or lower MS. BP: Measured continuously at rest (5-min) and during a 3-min SCWT (finger photoplethysmography calibrated to oscillometric-derived values). SCWT responses: Assessed as difference between 1-min peak systolic (SBP) and diastolic BP (DBP) and resting BP. Unpaired t-tests addressed a priori hypotheses within testosterone use (i.e., use vs. no use) and MS groups (i.e., higher vs. lower); mixed-effects analyses assessed main effects and interactions between testosterone use and MS. Results: Eight participants self-identified as transgender and 10 as non-binary. Ten participants reported current testosterone use (duration: 3±2 years; range: 0.33-6 years). Most testosterone users reported parenteral administration (n=9); 1 participant reported using a gel formulation. Age and BMI did not differ by testosterone use (P=0.58 and P=0.69, respectively) or by MS (P=0.20 and P=0.87). Resting SBP and DBP did not differ by testosterone use (P=0.56 and P=0.18) or by MS (P=0.95 and P=0.59), nor was there a testosterone-by-MS interaction for resting SBP (P=0.52) or DBP (P=0.95). Peak SCWT-induced increases in SBP and DBP did not differ by testosterone use (P=0.16 and P=0.28). A main effect of MS on both SCWT-induced increases in SBP (P< 0.01) and DBP (P< 0.01), without testosterone-by-MS interactions for SBP (P=0.80) or DBP (P=0.42), indicated that SCWT pressor responses were greater in TNBF with lower MS (SBP: +13±6 mmHg; DBP: +9±4 mmHg) than in those with higher MS (SBP: +4±4 mmHg, P< 0.01; DBP: +3±2 mmHg, P< 0.01). Conclusion: In this sample of TNBF adults, BP responses to acute mental stress were influenced by MS but not by testosterone use. These findings suggest that (a) high MS may blunt acute pressor responses in TNBF adults, and (b) MS may play a more prominent role than testosterone use in shaping acute mental stress-induced pressor responses in TNBF adults. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.