Hormone Therapy May Affect Cardiovascular Profiles in Transgender Persons

hormone therapy
hormone therapy
Investigators evaluated whether treatment with one year of oral or transdermal administration of estrogen plus cyproterone and transdermal or intramuscular application of testosterone caused changes in serum lipids and blood pressure.

In transgender patients undergoing hormone therapy, testosterone had a negative effect on lipids and lipoprotein concentrations, whereas estrogen plus cyproterone acetate was associated with a more favorable lipid profile, according to study findings published in The Journal of Clinical Endocrinology & Metabolism.

The role of sex hormones in cardiovascular disease has not been fully elucidated despite extensive research, but as the field of transgender medicine continues to grow, the cardiovascular implications of long-term gender-affirming hormone therapy also remain unclear. The study researchers assessed the changes in serum lipids and blood pressure (BP) during hormone therapy in a large cohort of transgender individuals. Conducted as a substudy in the European Network for the Investigation of Gender Incongruence, 242 trans women and 188 trans men were evaluated before and after receiving 12 months of hormone therapy.

After a year of hormone treatment, diastolic BP increased (2.5%; 95% CI, 0.6-4.4) in trans men, as did total cholesterol (4.1%; 95% CI, 1.5-6.6), low-density lipoprotein cholesterol (13.0%; 95% CI, 9.2-16.8), and triglycerides (36.9%; 95% CI, 29.8-44.1), whereas high-density lipoprotein cholesterol declined (10.8%; 95% CI, -14 to -7.6). In trans women, hormone treatment was associated with a modest decline in systolic BP (-2.6%; 95% CI, -4.2 to -1.0) and diastolic BP (-2.2%; 95% CI, -4 to -0.4), and it also decreased total cholesterol (-9.7%; 95% CI, -11.3 to -8.1), low-density lipoprotein cholesterol (-6%; 95% CI, -8.6 to 3.6), high-density lipoprotein cholesterol (-9.3%; 95% CI, -11.4 to -7.3), and triglycerides (-10.2%; 95% CI, -14.5 to -5.9).

“The clinical relevance of these findings remains a matter for debate, as long-term studies assessing clinical outcomes in cross-sex hormone are lacking,” the researchers concluded. “[U]ntil large trials assessing clinical outcomes in gender affirming hormone therapy are available, preventive measurements such as a healthy diet, exercise, and smoking cessation which apply to the general population are also applicable in transgender medicine.”

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van Velzen DM, Paldino A, Klaver M, et al. Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen [published online January 2, 2019]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-02138