The Effect of Gender-Affirming Hormone Therapy on the Risk of Subclinical Atherosclerosis in the Transgender Population: A Systematic Review

Roberta M C Moreira Allgayer; Gustavo da Silva Borba; Ruy Silveira Moraes; Ramon Bossardi Ramos; Poli Mara Spritzer

doi:10.1016/j.eprac.2022.12.017

The Effect of Gender-Affirming Hormone Therapy on the Risk of Subclinical Atherosclerosis in the Transgender Population: A Systematic Review

Endocr Pract. 2023 Jun;29(6):498-507. doi: 10.1016/j.eprac.2022.12.017. Epub 2023 Jan 2.

Authors

Roberta M C Moreira Allgayer¹, Gustavo da Silva Borba², Ruy Silveira Moraes³, Ramon Bossardi Ramos⁴, Poli Mara Spritzer⁵

Affiliations

¹ Gynecological Endocrinology Unit, Division of Endocrinology, and Gender Identity Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Post-graduate Program in Endocrinology, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
² Gynecological Endocrinology Unit, Division of Endocrinology, and Gender Identity Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
³ Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
⁴ Post-graduate Program in Endocrinology, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York.
⁵ Gynecological Endocrinology Unit, Division of Endocrinology, and Gender Identity Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Post-graduate Program in Endocrinology, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Department of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: spritzer@ufrgs.br.

PMID: 36603652
DOI: 10.1016/j.eprac.2022.12.017

Abstract

Objective: The impact of gender-affirming hormone therapy (GAHT) on cardiovascular (CV) health is still not entirely established. A systematic review was conducted to summarize the evidence on the risk of subclinical atherosclerosis in transgender people receiving GAHT.

Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data were searched in PubMed, LILACS, EMBASE, and Scopus databases for cohort, case-control, and cross-sectional studies or randomized clinical trials, including transgender people receiving GAHT. Transgender men and women before and during/after GAHT for at least 2 months, compared with cisgender men and women or hormonally untreated transgender persons. Studies reporting changes in variables related to endothelial function, arterial stiffness, autonomic function, and blood markers of inflammation/coagulation associated with CV risk were included.

Results: From 159 potentially eligible studies initially identified, 12 were included in the systematic review (8 cross-sectional and 4 cohort studies). Studies of trans men receiving GAHT reported increased carotid thickness, brachial-ankle pulse wave velocity, and decreased vasodilation. Studies of trans women receiving GAHT reported decreased interleukin 6, plasminogen activator inhibitor-1, and tissue plasminogen activator levels and brachial-ankle pulse wave velocity, with variations in flow-mediated dilation and arterial stiffness depending on the type of treatment and route of administration.

Conclusions: The results suggest that GAHT is associated with an increased risk of subclinical atherosclerosis in transgender men but may have either neutral or beneficial effects in transgender women. The evidence produced is not entirely conclusive, suggesting that additional studies are warranted in the context of primary prevention of CV disease in the transgender population receiving GAHT.

Systematic review registration: PROSPERO, identifier CRD42022323757.

Keywords: atherosclerosis; cardiovascular risk; estrogens; gonadal steroids; testosterone; transgender people.

Publication types

Systematic Review
Review

MeSH terms

Ankle Brachial Index
Atherosclerosis* / epidemiology
Atherosclerosis* / prevention & control
Cross-Sectional Studies
Female
Hormones
Humans
Male
Pulse Wave Analysis
Tissue Plasminogen Activator
Transgender Persons*

Substances

Tissue Plasminogen Activator
Hormones