ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This systematic review and meta-analysis included 22 studies, with a total of 19,893 transgender women, 14,840 transgender men, 371,547 cisgender men, and 434,700 cisgender women, to assess the occurrence of cardiovascular events. The risk of the combined outcome (stroke, myocardial infarction or thrombosis) was 40% higher in transgender people compared to cisgender people of the same birth-registered sex.

Gender-affirming therapy may play role in the increased risk of cardiovascular morbidity and mortality. Estrogen therapies are associated with increased risk of venous thromboembolism; transgender women were indeed found to have a relative risk of 2.2 (95% CI, 1.1-4.5) for thrombosis compared to cisgender men. Gender-affirming surgeries, like any major surgeries, may also predispose to thromboembolism. On the other hand, the risk of arterial cardiovascular events was similar in transgender men compared to transgender women, which seems surprising as testosterone therapy (but not estrogen) has been associated with an adverse impact on cardiovascular risk factors and with a higher risk of subclinical atherosclerosis in transgender individuals (1,2). This suggests that non-hormonal factors may play a role, such as minority stress, socioeconomic conditions and lifestyle factors.

Prospective studies that collect information on these factors are necessary to better understand the underlying causes of the increased cardiovascular morbidity in transgender people, and to compare the risk between different hormone formulations, doses and routes of administration. In the meantime, cardiovascular risk management should be an integral part of transgender care.

References: 1. Gosiker B, Moutchia J, Nguyen N, Getahun D, Goodman M. Changes in Blood Lipids Following Initiation of Gender Affirming Hormone Therapy: A Systematic Review and Meta-Analysis. J Clin Transl Endocrinol. 2024 Apr 30;36:100349. doi: 10.1016/j.jcte.2024.100349. PMID: 38737626; PMCID: PMC11087959.2. Moreira Allgayer RMC, Borba GDS, Moraes RS, Ramos RB, Spritzer PM. 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. PMID: 36603652.