Cardiometabolic Effects of Testosterone in Transmen and Estrogen Plus Cyproterone Acetate in Transwomen

Velzen, Daan van; Paldino, Alessia; Klaver, Maartje; Nota, Nienke M.; Defreyne, Justine; Hovingh, G. Kees; Thijs, Abel; Şimşek, Suat; T’Sjoen, Guy; Heijer, Martin den

doi:10.1210/jc.2018-02138

Cited by 68 publications

(63 citation statements)

References 54 publications

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“…31 A recent prospective observational study from Europe found negligible effects of HT on blood pressure in a cohort of transmen and transwomen after 12 months of HT. 9 We found that a history of progestin, but not estrogen, prescriptions was protective for HTN, though we also found increased duration of oral estrogen use decreased HTN.…”

Section: Discussionmentioning

confidence: 48%

“…6 There is limited research regarding the long-term safety of gender-affirming hormonal therapy for transgender patients, with most of the studies coming primarily from Europe. [6][7][8][9][10] Given differences in health care access and preferred regimens, additional information is clearly needed regarding HT and CVD risk among transgender patients in the United States. 11,12 Feminizing HT consists of an estrogen formulation that is usually co-administered with an androgen antagonist (such as spironolactone, commonly used in the United States, or cyproterone acetate, CPA, an antiandrogen agent with progestational properties that is commonly used in Europe).…”

Section: Introductionmentioning

confidence: 99%

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An Observational Study of Hypertension and Thromboembolism Among Transgender Patients Using Gender-Affirming Hormone Therapy

et al. 2020

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Purpose: Given evidence from cisgender patients that sex hormones can impact risk for some forms of cardiovascular disease (CVD), there are concerns regarding CVD among transgender patients using gender-affirming hormone therapy (HT). Methods: Using a retrospective cohort at a U.S. urban federally qualified health center (FQHC) focused on sexual and gender minority health, we examined associations between HT in transgender patients and two specific CVD outcomes, hypertension (HTN) and thromboembolism (TE). We assessed outcomes by ICD-10 codes in electronic medical records (EMR) of 4402 transgender patients. Hormone use was assessed both by blood concentrations and by prescriptions, from EMR. Results: Nineteen transwomen (TW) (0.8%) had a TE and 49 (2.1%) developed HTN; among transmen (TM), 27 (1.5%) developed HTN and there were no significant associations between hormones and HTN. Among transwomen, there was no association between TE and HT as assessed by blood concentrations. However, recent progestin prescriptions were associated with an increased odds of TE (adjusted odds ratio [aOR] 2.95 [95% confidence interval; CI 1.02-8.57]), with possibly differential effects for medroxyprogesterone acetate versus micronized progesterone. Higher total testosterone blood concentrations were associated with greater odds of HTN in TW (aOR 1.16 [95% CI 1.01-1.33]), after controlling for body mass index. Among TW, ever having a progestin prescription was protective for HTN (aOR 0.36 [95% CI 0.15-0.87]). Conclusion: We found no associations between HT and HTN among TM, More research is needed to examine the effect of recent progestin, specifically medroxyprogesterone acetate, on TE among transwomen. The protective association between progestins and HTN among TW is reassuring.

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Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

An Observational Study of Hypertension and Thromboembolism Among Transgender Patients Using Gender-Affirming Hormone Therapy

et al. 2020

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“…Reports on BMI among the transgender population have been mixed. Two prospective observational studies conducted in Europe reported that BMI increased in transgender women after 12 months of GAHT [30] , [38] , [39] . Another longitudinal cohort study in transgender girls in Europe also reported a significant increase in BMI from the start of GAHT from a mean age of 15 years up to the age of 22 years [40] .…”

Section: Discussionmentioning

confidence: 99%

Effects of gender affirming hormone therapy on body mass index in transgender individuals: A longitudinal cohort study

Suppakitjanusant

Stevenson

et al. 2020

Journal of Clinical & Translational Endocrinology

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Introduction Many transgender people take hormone therapy to affirm their gender identity. One potential long-term consequence of gender affirming hormone therapy is increased body mass index (BMI), which may be associated with metabolic syndrome, cardiovascular disease and higher mortality. Only a few published studies explored changes in BMI in transgender people taking gender affirming hormone therapy (GAHT). Objective To examine the changes in BMI longitudinally in response to GAHT in transgender women and men. Methods We conducted a retrospective cohort study of transgender individuals who received GAHT from the endocrinology clinic between January 1, 2000 and September 6, 2018. Subjects who sought GAHT were included if they had two separate measurements of BMI and were excluded if they had a BMI greater than 35 kg/m 2 or were missing demographic data at entry. We used a linear mixed model to analyze the longitudinal change in BMI. Results There were a total of 227 subjects included in this cohort. Among subjects already on GAHT, transgender women were receiving GAHT longer than transgender men (6.59 ± 9.35 vs 3.67 ± 3.43 years, p-value = 0.04). Over the period of 7 years, there was a significant increase in BMI in transwomen who newly initiated GAHT (p-value 0.004). There were no changes in BMI in transgender men and women already on GAHT or in transgender men who newly initiated GAHT in the study. Conclusion We conclude that BMI significantly increases in transwomen but not in transmen after initiation of GAHT in a single center based in the United States. In transwomen and transmen, BMI appears to be stable following 3 to 6 years of GAHT. Future investigations should examine the causes for increased BMI in transgender women including type of GAHT, diet and lifestyle, and association with risk of metabolic syndrome and cardiovascular disease.

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“…Of the included studies, all studies were pre-post observational studies without control groups. Only one study provided the device used to measure BP (BP-8800; Colin Corporation, Hayashi, Japan) [19], the position of measurement was acknowledged in four studies [19][20][21], and the use of multiple BP measurements mentioned in three studies [19,20,22].…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Transgender adults, gender-affirming hormone therapy and blood pressure: a systematic review

Connelly

Clark

Touyz

et al. 2020

Journal of Hypertension

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Objectives: Gender-affirming hormone therapy (GHT) is utilized by people who are transgender to align their secondary sex characteristics with their sex identity. Data relating to cardiovascular outcomes in this population are limited. We aimed to review the impact of GHT on the blood pressure (BP) of transgender individuals. Methods: We searched PubMed/MEDLINE, SCOPUS and Cochrane Library databases for articles published relating to the BP of transgender adults commencing GHT. Methodological quality was assessed via the 'Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group'. Results: Six hundred articles were screened, of which 14 studies were included in this systematic review encompassing 1309 individuals ($50% transgender men and women) treated with GHT between 1989 and 2019. These articles were all pre-post observational studies without control groups. Mean ages ranged between 23.0-36.7 years (transgender men) and 25.2-34.8 years (transgender women). Interventions were diverse and included oral, transdermal and injectable hormonal preparations with 4 months to 5 years follow-up. Most studies in transgender men did not demonstrate a change in BP, whereas transgender women on GHT demonstrated an increase in SBP but not DBP. These studies were heterogenous with significant methodological limitations and only two were determined to have a good quality rating. Conclusion: There is currently insufficient data to advise the impact of GHT on BP in transgender individuals. Better quality research is essential to elucidate whether exogenous sex hormones modulate BP in transgender people and whether this putative alteration infers poorer cardiovascular outcomes.

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Cardiometabolic Effects of Testosterone in Transmen and Estrogen Plus Cyproterone Acetate in Transwomen

Cited by 68 publications

References 54 publications

An Observational Study of Hypertension and Thromboembolism Among Transgender Patients Using Gender-Affirming Hormone Therapy

An Observational Study of Hypertension and Thromboembolism Among Transgender Patients Using Gender-Affirming Hormone Therapy

Effects of gender affirming hormone therapy on body mass index in transgender individuals: A longitudinal cohort study

Transgender adults, gender-affirming hormone therapy and blood pressure: a systematic review

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