A study of transgender people receiving gender-affirming hormone therapy found that certain hormones increased certain cardiometabolic risk factors.
Gender-affirming or cross-sex hormone therapy is integral to the management of transgender individuals, but there is only limited understanding of the effects of such hormones on cardiovascular health. Research is limited by the absence of large cohort studies, lack of appropriate control populations, and inadequate data acquisition from gender identity services. Existing epidemiological data suggest that the use of oestrogens in transgender females increases the risk of myocardial infarction and ischaemic stroke. Conversely, testosterone use in transgender males is currently lacking any consistent or convincing evidence of increased risk of cardiovascular or cerebrovascular disease.
This retrospective study included 129 transgender individuals receiving gender-affirming hormone therapy. In transgender males receiving testosterone, there was an average 2.5% drop in HDL cholesterol levels seen each year of using gender-affirming hormone therapy (P=0.03). However, researchers did not see this change in transgender females on estradiol during the average 48-month follow-up period. Additionally, the researchers found no significant changes in LDL cholesterol, triglycerides, HbA1c, or 25-hydroxyvitamin D levels in transgender males or transgender females.
About 53% of the participants in the study identified as transgender males, and more than 60% of the cohort was white. The median age of the total cohort was 26 with a BMI of 25.5. The majority of transgender males were on intramuscular injectable preparations of testosterone cypionate.
Similar to prior studies, a significant decrease in HDL was noted in TM on testosterone therapy. The researchers noted that further study is needed on the correlation of this finding with changes in diet and exercise while on testosterone therapy and impact on cardiovascular events. Reassuringly, no other changes noted in cardiovascular parameters.
“Further long-term data is needed for patients receiving this hormone therapy to assure that their long-term cardiovascular risk is optimised,” concluded Samihah Ahmed, MD, MBA, of Northwell Health Lenox Hill Hospital in New York City, who presented the findings.
Source: MedPage Today
Presentation information: Ahmed S, et al “Cardiometabolic risk factors in transgender individuals taking gender-affirming hormone therapy through four years” AACE 2021.
