Patients receiving hormone therapy as part of their gender-transition treatment had an elevated risk for cardiovascular events, including strokes, heart attacks and blood clots, according to a study published in the American Heart Association’s journal Circulation.
Gender-transition treatment poses an elevated risk for cardiovascular events, according to research
The results are based on 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, M.D., a researcher in the department of endocrinology at the Amsterdam University Medical Center. “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.”
HRT increases cardiovascular risk among people receiving it to alleviate symptoms of menopause
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 said.
Analysis involved 2517 transgender women
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.
Risk gauged to determine incidence of acute cardiovascular events
To gauge risk, the researchers determined the incidence of acute cardiovascular events—heart attacks, strokes and deep vein thromboses (). They compared the incidence of such cases in the transgender population to that reported in the general population. Transwomen were followed for an average of 9 years since start of hormone therapy, while transmen were followed for an average of 8 years after starting with hormones.
Analysis of transwomen
The analysis showed that transwomen — individuals assigned male sex at birth but with female gender identity 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 transwomen (73) than women (13) and 4.5 times more than men (73 versus 16). Heart attacks occurred at more than twice the rate among transwomen (30) than women (13). Transmen—those assigned female sex at birth but who had male gender identity and received hormones — had a more than three-fold elevation in heart-attack risk compared with women (11 versus 3).
Study was not designed to tease out the mechanism behind increased risk
The study was not designed to tease out the mechanism behind the increased risk. The researchers caution that their study was based solely on a review of medical records and could not account for risk factors such as smoking, psychosocial stressors, dietary and exercise habits. While those risk factors probably contribute to the increased cardiovascular risk, the researchers suggest that the hormone therapy may contribute to increased risk as well.
Previous studies have shown both triglyceride and insulin levels increased as a result of estrogen therapy
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 render the blood more prone to clotting, which may explain the higher rate of strokes and blood clots observed in transwomen, the authors said. The rise in heart attack risk observed in transmen 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.
Razi Berry is the founder and publisher of the journal Naturopathic Doctor News & Review that has been in print since 2005 and the premier consumer-faced website of naturopathic medicine, NaturalPath. She is the host of The Natural Cancer Prevention Summit and The Heart Revolution-Heal, Empower and Follow Your Heart, and the popular 10 week Sugar Free Summer program. From a near death experience as a young girl that healed her failing heart, to later overcoming infertility and Chronic Fatigue Syndrome and Fibromyalgia through naturopathic medicine, Razi has lived the mind/body healing paradigm. Her projects uniquely capture the tradition and philosophy of naturopathy: The healing power of nature, the vital life force in every living thing and the undeniable role that science and mind/body medicine have in creating health and overcoming dis-ease. Follow Razi on Facebook at Razi Berry and join us at Love is Medicine to explore the convergence of love and health.