Brugada Syndrome Unmasked by Use of Testosterone in a Transgender Male: Gender Trumps Sex as a Risk Factor

We describe a genetic female living as a transgender male through the use of exogenous testosterone supplementation. He developed Brugada pattern (that was unrecognized) and subsequently had an out-of-hospital cardiac arrest. Sustained ventricular arrhythmias were suppressed through treatment with quinidine; however, this medication could only be administered at very low doses due to the development of angioedema at higher doses. Subsequently, the patient required endocardial ablation for elimination of highly symptomatic, repetitive monomorphic ventricular ectopy. This case highlights the presentation of a unique patient in whom a channelopathy was unmasked by the patient's lifestyle, suggesting that gender trumps sex when it comes to arrhythmia risk in patients at risk for Brugada syndrome.