Skip to main content

Advertisement

SpringerLink
Log in

Cardiovascular health in transgender people

  • Published:
Reviews in Endocrine and Metabolic Disorders Aims and scope Submit manuscript

Abstract

This review examines the relationship between exogenous sex steroids and cardiovascular events and surrogate markers in trans (transgender) people. Data from trans populations is compared to data from postmenopausal women and hypogonadal men when appropriate. In an age-adjusted comparison with cisgender people, trans people appear to have an increased risk for myocardial infarction and death due to cardiovascular disease. It is uncertain whether hormone therapy in trans people affects their risk of stroke. In studies that followed trans people on hormone therapy, the rates of myocardial infarction and stroke were consistently higher in trans women than trans men. There is strong evidence that estrogen therapy for trans women increases their risk for venous thromboembolism over 5 fold. Extrapolating from studies of hormone therapy in postmenopausal women, transdermal estrogen likely carries a lower risk for venous thromboembolism than oral estrogen. Regarding red blood cells, testosterone therapy increases hemoglobin in trans men, and lowering testosterone in trans women has the opposite effect. Regarding blood pressure, the effects of hormone therapy on systolic blood pressure in trans women are inconsistent, with most studies showing an increase. In trans men, testosterone therapy consistently increases systolic blood pressure and may increase diastolic blood pressure. For lipids, hormone therapy may increase triglycerides in both trans women and men. In trans men, testosterone therapy also may increase LDL-cholesterol and decrease HDL-cholesterol.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Neumann F. The antiandrogen cyproterone acetate: Discovery, chemistry, basic pharmacology, clinical use and tool in basic research. Exp Clin Endocrinol. 1994;102(1):1–32.

    Article  CAS  Google Scholar 

  2. Corvol P, Michaud A, Menard J, Freifeld M, Mahoudeau J. Antiandrogenic effect of spirolactones: Mechanism of action. Endocrinology. 1975;97(1):52–8.

    Article  CAS  Google Scholar 

  3. Schürmeyer T, Nieschlag E. Comparative pharmacokinetics of testosterone enanthate and testosterone cyclohexanecarboxylate as assessed by serum and salivary testosterone levels in normal men. Int J Androl. 1984;7(3):181–7.

    Article  Google Scholar 

  4. Africander D, Verhoog N, Hapgood JP. Molecular mechanisms of steroid receptor-mediated actions by synthetic progestins used in HRT and contraception. Steroids. 2011;76(7):636–52.

    Article  CAS  Google Scholar 

  5. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the women’s health initiative randomized trials. JAMA. 2013;310(13):1353–68.

    Article  CAS  Google Scholar 

  6. Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: A meta-analysis. Menopause. 2006;13(2):265–79.

    Article  Google Scholar 

  7. Muka T, Oliver-Williams C, Kunutsor S, et al. Association of age at onset of menopause and time since onset of menopause with cardiovascular outcomes, intermediate vascular traits, and all-cause mortality: A systematic review and meta-analysis. JAMA Cardiol. 2016;1(7):767–76.

    Article  Google Scholar 

  8. Boardman HM, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2015;(3):CD002229.

  9. Onasanya O, Iyer G, Lucas E, Lin D, Singh S, Alexander GC. Association between exogenous testosterone and cardiovascular events: An overview of systematic reviews. Lancet Diabetes Endocrinol. 2016;4(11):943–56.

    Article  CAS  Google Scholar 

  10. Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl J Med 2010;363(2):109–122.

  11. Finkle WD, Greenland S, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One 2014;9(1).

    Article  Google Scholar 

  12. Basaria S, Harman SM, Travison TG, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels: A randomized clinical trial. JAMA. 2015;314(6):570–81.

    Article  CAS  Google Scholar 

  13. Meyer IH, Brown TN, Herman JL, Reisner SL, Bockting WO. Demographic characteristics and health status of transgender adults in select US regions: Behavioral risk factor surveillance system, 2014. Am J Public Health. 2017;107(4):582–9.

    Article  Google Scholar 

  14. Dhejne C, Lichtenstein P, Boman M, Johansson ALV, Langstrom N, Landen M. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLoS One 2011;6(2).

    Article  CAS  Google Scholar 

  15. Maraka S, Singh Ospina N, Rodriguez-Gutierrez R, et al. Sex steroids and cardiovascular outcomes in transgender individuals: A systematic review and meta-analysis. J Clin Endocrinol Metab. 2017;102(11):3914–23.

    Article  Google Scholar 

  16. van Kesteren PJ, Asscheman H, Megens JA, Gooren LJ. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol. 1997;47(3):337–42.

    Article  Google Scholar 

  17. Asscheman H, Giltay EJ, Megens JAJ, De Ronde W, Van Trotsenburg, MAA, Gooren LJG. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol 2011;164(4):635–642.

    Article  CAS  Google Scholar 

  18. Wierckx K, Elaut E, Declercq E, et al. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: A case-control study. Eur J Endocrinol 2013;169(4):471–478.

    Article  CAS  Google Scholar 

  19. Wierckx K, Mueller S, Weyers S, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med 2012;9(10):2641–2651.

    Article  CAS  Google Scholar 

  20. Renoux C, Dell'aniello S, Garbe E, Suissa S. Transdermal and oral hormone replacement therapy and the risk of stroke: A nested case-control study. BMJ. 2010;340:c2519.

    Article  Google Scholar 

  21. Canonico M, Carcaillon L, Plu-Bureau G, et al. Postmenopausal hormone therapy and risk of stroke: Impact of the route of estrogen administration and type of progestogen. Stroke. 2016;47(7):1734–41.

    Article  CAS  Google Scholar 

  22. Canonico M, Oger E, Plu-Bureau G, et al. Hormone therapy and venous thromboembolism among postmenopausal women: Impact of the route of estrogen administration and progestogens: The ESTHER study. Circulation. 2007;115(7):840–5.

    Article  CAS  Google Scholar 

  23. Arnold JD, Sarkodie EP, Coleman ME, Goldstein DA. Incidence of venous thromboembolism in transgender women receiving oral estradiol. J Sex Med. 2016;13(11):1773–7.

    Article  Google Scholar 

  24. Ott J, Kaufmann U, Bentz E, Huber JC, Tempfer CB. Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy. Fertil Steril 2010;93(4):1267–1272.

    Article  Google Scholar 

  25. Seal LJ, Franklin S, Richards C, Shishkareva A, Sinclaire C, Barrett J. Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens. J Clin Endocrinol Metab. 2012;97(12):4422–8.

    Article  CAS  Google Scholar 

  26. Toorians AW, Thomassen MC, Zweegman S, et al. Venous thrombosis and changes of hemostatic variables during cross-sex hormone treatment in transsexual people. J Clin Endocrinol Metab. 2003;88(12):5723–9.

    Article  CAS  Google Scholar 

  27. Giltay EJ, Gooren LJ, Emeis JJ, Kooistra T, Stehouwer CD. Oral, but not transdermal, administration of estrogens lowers tissue-type plasminogen activator levels in humans without affecting endothelial synthesis. Arterioscler Thromb Vasc Biol. 2000;20(5):1396–403.

    Article  CAS  Google Scholar 

  28. Wierckx K, Van Caenegem E, Schreiner T, et al. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: Results from the European network for the investigation of gender incongruence. J Sex Med 2014;11(8):1999–2011.

    Article  CAS  Google Scholar 

  29. Quiros C, Patrascioiu I, Mora M, et al. Effect of cross-sex hormone treatment on cardiovascular risk factors in transsexual individuals. Experience in a specialized unit in catalonia. Endocrinol Nutr 2015;62(5):210–216.

    Article  Google Scholar 

  30. Emi Y, Adachi M, Sasaki A, Nakamura Y, Nakatsuka M. Increased arterial stiffness in female-to-male transsexuals treated with androgen. J Obstet Gynaecol Res. 2008;34(5):890–7.

    Article  Google Scholar 

  31. Pelusi C, Costantino A, Martelli V, et al. Effects of three different testosterone formulations in female-to-male transsexual persons. J Sex Med 2014;11(12):3002–3011.

    Article  Google Scholar 

  32. Jacobeit JW, Gooren LJ, Schulte HM. Long-acting intramuscular testosterone undecanoate for treatment of female-to-male transgender individuals. J Sex Med 2007;4(5):1479–1484.

  33. Costantino A, Cerpolini S, Alvisi S, Morselli PG, Venturoli S, Meriggiola MC. A prospective study on sexual function and mood in female-to-male transsexuals during testosterone administration and after sex reassignment surgery. J Sex Marital Ther 2013;39(4):321–335.

    Article  Google Scholar 

  34. Mueller A, Haeberle L, Zollver H, et al. Effects of intramuscular testosterone undecanoate on body composition and bone mineral density in female-to-male transsexuals. J Sex Med 2010;7(9):3190–3198.

    Article  CAS  Google Scholar 

  35. Elbers JMH, Giltay EJ, Teerlink T, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol 2003;58(5):562–571.

    Article  CAS  Google Scholar 

  36. Colizzi M, Costa R, Scaramuzzi F, et al. Concomitant psychiatric problems and hormonal treatment induced metabolic syndrome in gender dysphoria individuals: A 2year follow-up study. J Psychosom Res 2015;78(4):399–406.

    Article  Google Scholar 

  37. Gava G, Cerpolini S, Martelli V, Battista G, Seracchioli R, Meriggiola MC. Cyproterone acetate vs leuprolide acetate in combination with transdermal oestradiol in transwomen: A comparison of safety and effectiveness. Clin Endocrinol (Oxf). 2016;85(2):239–46.

    Article  CAS  Google Scholar 

  38. Price TM, Blauer KL, Hansen M, Stanczyk F, Lobo R, Bates GW. Single-dose pharmacokinetics of sublingual versus oral administration of micronized 17 beta-estradiol. Obstet Gynecol. 1997;89(3):340–5.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Andrology and Division of Endocrinology, Medical Faculty Associates, The George Washington University, 2300 M St NW, Washington, DC, 20037, USA

    Michael S. Irwig

Authors
  1. Michael S. Irwig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael S. Irwig.

Ethics declarations

Conflict of interest

Michael S. Irwig declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by the author.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Irwig, M.S. Cardiovascular health in transgender people. Rev Endocr Metab Disord 19, 243–251 (2018). https://doi.org/10.1007/s11154-018-9454-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11154-018-9454-3

Keywords

Search

Navigation