Surgical and pharmacological reassignment: influence on transsexual cardiovascular risk profile

Ciccone, Marco Matteo; Loverro, Giuseppe; Scicchitano, Pietro; Loverro, Matteo; Ricci, Gabriella; Scaramuzzi, Francesca; Gesualdo, Michele; Zito, Annapaola; Campagna, Marcello; Moncelli, Michele; Nicolardi, Vittorio; Manca, Fabio; Boninfante, Barbara; Carbonara, Santa; Cortese, Francesca; Todarello, Orlando; Bettocchi, Carlo

doi:10.1111/imj.13597

Cited by 7 publications

(6 citation statements)

References 54 publications

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“…70 Furthermore, people who are TGD who had undergone gender-affirming surgery and were receiving hormone therapy had reduced brachial artery flowmediated dilation compared with women and men who are transgender who had not undergone surgery but who were taking hormone therapy. 71 In secondary analyses, the results remained the same when separating by gender identity. However, the sample sizes in the surgery group likely lacked the power to detect differences.…”

Section: Vascular Health and Functionmentioning

confidence: 78%

Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association

Streed¹,

Beach²,

Caceres³

et al. 2021

Circulation

141

113

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There is growing evidence that people who are transgender and gender diverse (TGD) are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Prior literature has characterized disparities in cardiovascular morbidity and mortality as a result of a higher prevalence of health risk behaviors. Mounting research has revealed that cardiovascular risk factors at the individual level likely do not fully account for increased risk in cardiovascular health disparities among people who are TGD. Excess cardiovascular morbidity and mortality is hypothesized to be driven in part by psychosocial stressors across the lifespan at multiple levels, including structural violence (eg, discrimination, affordable housing, access to health care). This American Heart Association scientific statement reviews the existing literature on the cardiovascular health of people who are TGD. When applicable, the effects of gender-affirming hormone use on individual cardiovascular risk factors are also reviewed. Informed by a conceptual model building on minority stress theory, this statement identifies research gaps and provides suggestions for improving cardiovascular research and clinical care for people who are TGD, including the role of resilience-promoting factors. Advancing the cardiovascular health of people who are TGD requires a multifaceted approach that integrates best practices into research, health promotion, and cardiovascular care for this understudied population.

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Section: Vascular Health and Functionmentioning

confidence: 78%

Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association

Streed¹,

Beach²,

Caceres³

et al. 2021

Circulation

141

113

View full text Add to dashboard Cite

show abstract

“…38 In 56 transgender individuals, carotid intima-media thickness and flow-mediated dilation of the brachial artery was measured 2 to 3 months after gender reassignment procedures and compared with those receiving GHT alone. 39 Those undergoing surgery experience a reduction in flow-mediated dilation and increased carotid intimamedia thickness.…”

Section: Surrogate Markers Of Cardiovascular Risk In Transgender Peoplementioning

confidence: 99%

Gender-Affirming Hormone Therapy, Vascular Health and Cardiovascular Disease in Transgender Adults

et al. 2019

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Gender-affirming or cross-sex hormone therapy is integral to the management of transgender individuals yet our appreciation of the effects of such hormones on cardiovascular health is limited. Insights into vascular pathophysiology and outcomes in transgender people receiving sex steroids could be fundamental in providing better care for this population through the management of cardiovascular risk and more broadly advance our understanding of the role of sex and gender in vascular health and disease. In addition, there is a need to understand how gender-affirming hormone therapy impacts cardiovascular disease risk and events as transgender individuals age. This review explores the available evidence on the associations between gender-affirming hormones and cardiovascular events such as coronary artery disease, stroke, hypertension, thrombosis, lipid abnormalities, and diabetes mellitus. Current research about vascular outcomes in adults receiving hormonal therapy is limited by the absence of large cohort studies, lack of appropriate control populations, and inadequate data acquisition from gender identity services. Existing epidemiological data suggest that the use of estrogens in transgender females confers an increased risk of myocardial infarction and ischemic stroke. Conversely, transgender males receiving testosterone lack any consistent or convincing evidence of increased risk of cardiovascular or cerebrovascular disease. Further studies are required to confirm whether such risk exists and the mechanisms by which they occur.

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“…In particular, these molecules can play a role as a risk factor in a gender-independent manner; however, data suggest a potential role also in term of gender specificity. As previously discussed elsewhere [ 100 ], sex steroids can significantly influence cardiovascular risk in a gender-specific manner. Thus, potential exposure to Eds will have to be taken into consideration when factor risks for CVD are analysed.…”

Section: Therapies In the Context Of Eds Exposurementioning

confidence: 99%

Environmental Contaminants Acting as Endocrine Disruptors Modulate Atherogenic Processes: New Risk Factors for Cardiovascular Diseases in Women?

et al. 2021

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The number of aged individuals is increasing worldwide, rendering essential the comprehension of pathophysiological mechanisms of age-related alterations, which could facilitate the development of interventions contributing to “successful aging” and improving quality of life. Cardiovascular diseases (CVD) include pathologies affecting the heart or blood vessels, such as hypertension, peripheral artery disease and coronary heart disease. Indeed, age-associated modifications in body composition, hormonal, nutritional and metabolic factors, as well as a decline in physical activity are all involved in the increased risk of developing atherogenic alterations that raise the risk of CVD development. Several factors have been reported to play a role in the alterations observed in muscle and endothelial cells and that lead to increased CVD, such as genetic pattern, smoking and unhealthy lifestyle. Moreover, a difference in the risk of these diseases in women and men has been reported. Interestingly, in the past decades attention has been focused on a potential role of several pollutants that disrupt human health by interfering with hormonal pathways, and more specifically in non-communicable diseases such as obesity, diabetes and CVD. This review will focus on the potential alteration induced by Endocrine Disruptors (Eds) in the attempt to characterize a potential role in the cellular and molecular mechanisms involved in the atheromatous degeneration process and CVD progression.

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Surgical and pharmacological reassignment: influence on transsexual cardiovascular risk profile

Abstract: Cardiovascular risk, which is expressed in terms of endothelial (FMD) and morphological (C-IMT) dysfunction, increases in subjects undergoing gonadectomy compared with those receiving cross-sex reassignment therapy alone.

Cited by 7 publications

References 54 publications

Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association

Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association

Gender-Affirming Hormone Therapy, Vascular Health and Cardiovascular Disease in Transgender Adults

Environmental Contaminants Acting as Endocrine Disruptors Modulate Atherogenic Processes: New Risk Factors for Cardiovascular Diseases in Women?

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