Experts are highlighting the dearth of research on cardiovascular disease (CVD) and CVD risk factors in transgender populations receiving long-term cross-sex hormone therapy (CSHT), which they say limits appropriate primary and specialty care.
A narrative review, published in the Annals of Internal Medicine , examined 13 studies on the effect of CSHT on CVD among transgender persons. As with hormone therapy in cisgender persons, existing research in transgender populations suggests that CVD risk factors are altered by CSHT.
Despite the current limitations, the authors say the available literature suggests several key issues to consider when prescribing hormone therapy to both transgender adults. CSHT has been associated with worsening cardiovascular risk factors, such as increased blood pressure, insulin resistance and lipid derangements in transgender men. In transgender women, CSHT increases potential thromboembolic risk, and lower-dose transdermal oestrogen formulations are preferred over high-dose oral formulations. Clinicians must closely follow older transgender women if they have higher cardiovascular risk, regardless of the use, age of initiation, or duration of CSHT, the authors advise.
Reducing cardiovascular risk factors remains critical in preventing CVD in transgender populations, they add. However, despite the potential risks of CSHT, the authors stress that providing gender-affirming care has important psychosocial benefits.