Long-Term Androgen Therapy Increases Cardiovascular Risk in Transgender Men

carotid artery disease in testosterone therapy
carotid artery disease in testosterone therapy
Transgender men who are on long-term androgen therapy have higher levels of aortic stiffness, which may increase their risk for cardiovascular events.

Transgender men who receive long-term testosterone treatment may have a greater risk for cardiovascular events, according to study results presented at ENDO 2017, April 1-4, 2017 in Orlando, Florida.

Researchers from the Hospital das ClÍnicas at Faculdade de Medicina da Universidade de São Paulo in Brazil evaluated the structural and functional properties of large arteries in transgender men who were on long-term cross-sex hormone therapy compared with male and female control groups. 

As the researchers pointed out, androgens can cause changes in vascular structure and function, and the effects of therapy on cardiovascular function in transgender men are not well known, especially in terms of long-term treatment.

A total of 142 transgender men (mean age, 42±10) receiving intramuscular testosterone esters on regular treatment for at least 1 year (mean time of therapy, 11±10 years) were matched with 147 healthy controls (both male and female) for age and body mass index (BMI). The transgender men underwent carotid radiofrequency ultrasound for assessment of carotid intima-media thickness (CIMT), carotid diameter, and relative distensibility of the carotid artery. Aortic stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV) measurements.

Transgender men had higher mean cf-PWV values than healthy male controls (P =.005), but not female controls. In addition, higher cf-PWV values were observed in transgender men with hypertension vs transgender men without hypertension (P =.022).

In terms of age, transgender men who were at least 42 years old had higher cf-PWV values compared with both male and female controls (P <.001 and P =.024, respectively), regardless of arterial blood pressure values. The cf-PWV significantly correlated with age, androgen treatment duration, and waist-to-hip ratio in transgender men. However, there were no differences between transgender men and control participants in terms of CIMT, carotid diameter, or relative distensibility of the carotid artery.

“[This] investigation of early arterial changes in transgender men can provide new information about cardiovascular effect of the androgen therapy,” the researchers wrote.

They concluded that having higher levels of aortic stiffness, associated with hypertension and an increased waist-to-hip ratio, puts transgender men at a greater risk for cardiovascular events.

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Cunha FS, Costa EMF, Bachega T, et al. Effect of long-term androgen treatment of large arteries of transgender men. Abstract 125. Presented at: ENDO 2017: the 99th Annual Meeting & Expo. April 1-4, 2017; Orlando, Florida.