Gender transition hormone therapy might affect heart health

Washington: A new study revealed that patients receiving hormone therapy as a part of their gender-transition treatment are at an elevated risk of developing cardiovascular diseases, including strokes, heart attacks and blood clots. The study was published in ‘Circulation: Journal of the American Heart Association’.

The results are based on an analysis of medical records of 3,875 Dutch individuals who received hormone treatment between 1972 and 2015 as part of their gender transition. "In light of our results, we urge both physicians and transgender individuals to be aware of this increased cardiovascular risk," said study author Nienke Nota.

"It may be helpful to reduce risk factors by stopping smoking, exercising, eating a healthy diet and losing weight, if needed before starting therapy, and clinicians should continue to evaluate patients on an ongoing basis thereafter,” Nota added.

Past research has shown that hormone therapy increases cardiovascular risk among people receiving it to alleviate symptoms of menopause, yet research evidence remains scarce on the effects of hormone treatment in people undergoing gender transition.

Even though such individuals tend to be younger than menopausal patients receiving hormone-replacement therapy, transgender people may have more psychosocial stressors and other factors that increase cardiovascular risk, the researchers stated.

The analysis involved 2,517 transgender women, median age 30, who received estrogen, with or without androgen-suppressors, and 1,358 transgender men, median age 23, who received testosterone as part of their transition.

To gauge risk, the researchers determined the incidence of acute cardiovascular events like heart attacks, strokes and deep vein thromboses (blood clots). They compared the incidence of such cases in the transgender population to that reported in the general population. Transgender women were followed for an average of 9 years since start of hormone therapy, while transgender men were followed for an average of 8 years after starting with hormones.

The analysis showed that transgender women, who were receiving hormones as part of their transition had more than twice as many strokes as women (29 versus 12) and nearly twice as many strokes as men (29 versus 16).

There were five times as many deep-vein clots among transgender women (73) than women (13) and 4.5 times more than men (73 versus 16). Heart attacks occurred at more than twice the rate among transgender women (30) than women (13). Transgender men, who received hormones, had a more than three-fold elevation in heart-attack risk compared with women (11 versus 3).

The researchers suggested that the hormone therapy may contribute to increased risk as well. In previous studies it has been shown that triglyceride and insulin levels, for example, have both increased as a result of estrogen therapy and both are known to promote clogging and inflammation of the blood vessels.

Additionally, estrogen therapy can make the blood more prone to clotting, which may explain the higher rate of strokes and blood clots observed in transgender women, the authors said.

The rise in heart attack risk observed in transgender men receiving testosterone may be explained partly by the hormone's tendency to make the blood stickier by increasing the concentration of red blood cells along with lowering the level of good cholesterol and raising the level of bad cholesterol, the research team said.