Hormone therapy for gender dysphoria linked to higher cardiovascular risks
There may be significant cardiovascular risks associated with hormone replacement therapy for people with gender dysphoria, according to new data to be presented at the American College of Cardiology’s upcoming annual meeting, ACC.23 Together with the World Congress of Cardiology, in New Orleans.
Specifically, individuals with gender dysphoria who received hormone therapy—typically in the form of estrogen for people assigned male at birth or testosterone for people assigned female at birth—had higher rates of ischemic stroke, ST elevation myocardial infarction, and pulmonary embolism. However, hormone therapy replacements were not associated with a higher risk of death.
The most likely explanation for the increased risk of cardiovascular events, researchers said, is increased clotting activity in the blood. This is a known to be a side effect of taking estrogen or testosterone.
The findings are based on an examination of hospital records for over 21,000 people with gender dysphoria, including more than 1,675 people who had taken hormone replacement therapy. For the purpose of the analysis, all patients who had taken any type of hormone replacements at any time were grouped together, without taking into account the duration of treatment or the age at which treatment was initiated. These nuances could potentially be explored further in future studies, the researchers noted.
Aiding fully-informed decisions to begin hormone replacement therapy
Acknowledging that hormone therapy has risen among people who identify as transgender in the United States in recent years—especially among teens and young adults—the researchers explain that their work helps raise awareness of potential trade-offs, making sure that patients are fully informed before starting treatment.
“It's all about risks and benefits. Starting transitioning is a big part of a person's life and helping them feel more themselves, but hormone replacement therapy also has a lot of side effects—it's not a risk-free endeavor."
“It's all about risks and benefits,” said Ibrahim Ahmed, MD, a third-year resident at Mercy Catholic Medical Center in Darby, Pennsylvania and the study's lead author, in a prepared statement from the ACC. “Starting transitioning is a big part of a person's life and helping them feel more themselves, but hormone replacement therapy also has a lot of side effects—it's not a risk-free endeavor."
Overall, the study’s results highlight the need for healthcare providers to closely monitor the cardiovascular health of transgender individuals receiving hormone therapy, taking available steps to mitigate any potential risks.
Findings are scheduled to be presented March 5 at ACC.23/WCC. More details about the conference, including a full program and details about in-person and virtual registration, are available here.