Effects of Gender-Affirming Hormones on Lipid, Metabolic, and Cardiac Surrogate Blood Markers in Transgender Persons

Defreyne, Justine; Bruaene, Laurens D L Van de; Rietzschel, Ernst; Schuylenbergh, Judith Van; T’Sjoen, Guy

doi:10.1373/clinchem.2018.288241

Cited by 64 publications

(71 citation statements)

References 119 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, one randomized controlled trial suggests that dose of GAHT may impact changes in BMI [6] . In order to decrease cardiovascular morbidity, particularly among transgender women, more attention should be paid to decreasing cardiovascular risk factors such as BMI and other factors such as hypertension, hyperlipidemia, and tobacco use [60] . Furthermore, longer term studies evaluating the impact of GAHT on BMI and other risk factors need to be conducted.…”

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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…[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). In some cases finasteride is used to inhibit the effects of endogenous dihydrotestosterone; while some patients may also add-back testosterone to maintain energy and libido.…”

Section: Introductionmentioning

confidence: 99%

“…19 The effect of the currently widely prescribed HT on cardiac disease and mortality are not entirely clear and in some cases may be modified by aging. 5,11,[20][21][22][23] Therefore, our aim was to describe the rate of CVD among transgender patients using gender affirming HT in a large community health center that serves the largest transgender population in Illinois. Furthermore, we explored associations between each category of hormone and specific CVD outcomes, stratified by affirmed gender.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

“…Risk mitigation is an important part of the care of transgender patients due to the many risks associated with not providing hormone therapy (ie, poor mental health) and the potential risks associated with hormone therapy. Further study of the relationship between estrogen and the risk of VTE will serve to inform the safest possible care for transgender patients 42…”

Section: Resultsmentioning

confidence: 99%

<p>Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy</p>

Goldstein¹,

Khan²,

Reisman³

et al. 2019

JBM

View full text Add to dashboard Cite

Introduction: Venous thromboembolism (VTE) is a potential risk of estrogen therapy. However, data show an improvement in the quality of life for transgender people who use feminizing hormone therapy. With few transgender-specific data, guidance may be drawn from cisgender (nontransgender) data, with a focus on hormonal birth control and postmenopausal hormone replacement therapy (HRT). The aim of this review is to examine the degree to which routes of administration, patient comorbidities, and type of hormone utilized affect the safety of estrogen therapy. Methods: We identified 6,349 studies by searching PubMed with the terms “transgender”, “estrogen”, “VTE”, and “HRT”. Of these, there were only 13 studies between 1989 and 2018 that investigated the effects of hormone therapy, including types of estrogens used, in transgender women and men. Results: The data suggest that the route of hormone administration, patient demographics, and patient comorbidities all affect estrogen’s link with VTE. For example, avoiding ethinyl estradiol might make the use of hormone therapy in trans feminine individuals safer than oral birth control. Data from both cis and trans groups suggest additional VTE risk associated with the use of progestins. While transdermal estrogens dosed up to 0.1 mg/day or below appear lower risk for VTE than other forms of estrogen, it is unclear whether this is related to the delivery method or a dose effect. Finally, even if the risk from exogenous estrogen use remains significant statistically, the absolute clinical risk remains low. Conclusion: Clinicians should avoid the use of ethinyl estradiol. Additionally, data suggest that progestins should be avoided for transgender individuals. Further study of the relationship between estrogen use and the risk of VTE will serve to inform the safest care strategies for transgender individuals.

show abstract

Effects of Gender-Affirming Hormones on Lipid, Metabolic, and Cardiac Surrogate Blood Markers in Transgender Persons

Cited by 64 publications

References 119 publications

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

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

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

<p>Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy</p>

Contact Info

Product

Resources

About