Surgical and pharmacological reassignment: influence on transsexual cardiovascular risk profile

Intern Med J. 2017 Nov;47(11):1255-1262. doi: 10.1111/imj.13597.

Abstract

Background/aim: To evaluate and stratify early cardiovascular risk of transsexuals who underwent pharmacological and/or surgical gender reassignment.

Methods: Fifty-six transsexuals were divided into two groups: group 1 - underwent gonadectomy (orchiectomy for transwomen and hystero-annessiectomy for transmen); group 2 - hormone replacement therapy alone. All participants underwent carotid artery intima-media thickness (C-IMT) and flow-mediated vasodilation (FMD) of brachial artery evaluations.

Results: FMD was lower in patients who had undergone gonadectomy compared with non-surgically treated patients (Group 1: 5.711 vs Group 2: 7.339, P < 0.0001). Mean C-IMT was higher in group 1 than group 2 (group 1: 0.733 vs group 2: 0.582). The duration of hormone therapy correlates positively with mean C-IMT (B = 0.001) and negatively with FMD (%) (B = - 0.007).

Conclusions: 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.

Keywords: cardiovascular risk; carotid intima-media thickness; flow-mediated dilation; transsexuals.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Brachial Artery / diagnostic imaging
  • Brachial Artery / physiology
  • Cardiovascular Diseases / diagnostic imaging*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology
  • Carotid Intima-Media Thickness / trends
  • Cohort Studies
  • Female
  • Hormone Replacement Therapy / adverse effects*
  • Hormone Replacement Therapy / trends
  • Humans
  • Male
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Risk Factors
  • Sex Reassignment Surgery / adverse effects*
  • Sex Reassignment Surgery / trends
  • Transsexualism / diagnostic imaging*
  • Transsexualism / physiopathology
  • Transsexualism / surgery*