Written by Joyce Smith, BS. This study finds that transmen and transwomen are at higher risk of heart attacks than ciswomen while the incidences of strokes and blood clots are higher in transgender women receiving transgender hormone therapy than in both cismen and ciswomen.
According to recent reports, approximately 1.4 million persons (0.6 percent) identify as transgender 1. Although these transgender adults, who often receive transgender hormone therapy (THT), have a potential increased risk of cardiovascular events (CVEs) such as myocardial infarcts (heart attacks, strokes (both ischemic and hemorrhagic), and venous thromboembolic events (blood clots), there is insufficient evidence regarding an increased risk 2 .
For their study 3, the researchers based their results on analyzed data of medical records of 3,875 Dutch individuals who visited their gender clinic between 1972 and 2015 and received transgender hormone therapy (THT) as part of their gender transition. The participating 2,517 transgender women (median age 30) received estrogen with or without androgen suppressors, while the 1,358 participating transgender men (median age 23) received testosterone. Mean follow-up duration was 9 years for transwomen and 5.9 years for transmen.
Compared with cisgender women and men (whose sense of personal identity and gender corresponds with their birth sex) in the general Dutch or Norwegian population, transwomen had significantly more cardiovascular events. Transwomen, (individuals who were male sex at birth but with female gender identity and receiving hormone therapy as part of their transition) had more than double the amount of strokes as ciswomen (29 vs 12) and nearly twice as many strokes as cismen (29 vs 16). Transwomen also had five times as many deep vein thrombosis than ciswomen (73 vs 13) and 4.5 times as many blood clots as cismen (73 vs 16).
The one exception was heart attacks (MIs) for which cisgender men had the highest risk. MIs among transwomen more than doubled compared to ciswomen (30 vs 11). However, transmen (those who were female sex at birth but with male gender identity and receiving hormone therapy) had more than triple increased risk of MIs compared with ciswomen (11 versus 3).
Researchers note that the study analysis cannot prove a causal relationship. The review of only medical records could not account for confounding risk factors such as smoking status or stressors, for example. Even though transgenders 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; therefore, mitigating these risk factors through exercise, weight loss, a healthy diet, and smoking cessation prior to pursuing hormone therapy may be helpful. While these risk factors probably contribute to an increased cardiovascular risk, researchers suggest that the hormone therapy may contribute to an increased risk as well and recommend that doctors pursue a diligent, ongoing clinical evaluation of patients during- and post-hormone therapy.
Source: Nota, Nienke M., Chantal M. Wiepjes, Christel JM de Blok, Louis JG Gooren, Baudewijntje PC Kreukels, and Martin den Heijer. “Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy: Results From a Large Cohort Study.” Circulation 139, no. 11 (2019): 1461-1462.
© 2019 American Heart Association, Inc.
Posted April 15, 2019.
Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.
References:
- Streed CG, Jr., Harfouch O, Marvel F, Blumenthal RS, Martin SS, Mukherjee M. Cardiovascular Disease Among Transgender Adults Receiving Hormone Therapy: A Narrative Review. Ann Intern Med. 2017;167(4):256-267.
- Getahun D, Nash R, Flanders WD, et al. Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Ann Intern Med. 2018;169(4):205-213.
- Nota NM, Wiepjes CM, de Blok CJM, Gooren LJG, Kreukels BPC, den Heijer M. Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy. Circulation. 2019;139(11):1461-1462.
