An analysis of two decades of electronic health records reveals that transgender and gender-diverse (TGD) individuals have a prevalence of hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) up to 18 times higher than the cisgender population.
The study, published in LGBT Health in January 2026, compared the frequency of these diagnoses between TGD and cisgender individuals using an electronic health record database spanning 2004 to 2024. Researchers identified TGD individuals through ICD-10 codes related to gender identity and stratified them by hormone therapy status. Cisgender comparison groups were defined by the absence of gender identity diagnoses and hormone therapy exposure.
The results are striking. The odds ratio (OR) for hEDS or HSD in TGD individuals compared with cisgender individuals was 18.45. Prevalence among TGD individuals assigned female at birth reached 2.62%, compared with 0.16% in cisgender females. Among TGD individuals assigned male at birth, prevalence was 1.00%, compared with 0.04% in cisgender males. Notably, hormone therapy status was not associated with significant differences in prevalence, suggesting the link does not depend on hormonal treatment but on underlying factors, likely genetic and related to connective tissue development.
hEDS and HSD are hereditary connective tissue disorders affecting collagen production and function. They manifest with hypermobile joints, joint instability, chronic pain, fatigue and, sometimes, dysautonomia. Although their genetic basis is heterogeneous and a specific variant is not always identified, familial aggregation is common. The historical underrepresentation of TGD people in clinical studies has contributed to these disorders going unnoticed in this population, delaying diagnosis and complicating management.
The authors stress that their findings do not imply a causal relationship between gender identity and hypermobility, but rather a significantly higher disease burden that calls for greater clinical recognition and multidisciplinary management strategies. The coexistence of gender dysphoria and connective tissue disorders poses specific challenges in preoperative assessment, rehabilitation and long-term follow-up. The study reinforces the need to include a gender perspective in biomedical research and to train clinical teams in detecting these conditions in TGD individuals.
Source: LGBT Health (2026). DOI: 10.1177/23258292251382250. Retrospective cohort study based on electronic health records (2004-2024).
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