An Observational Study of Hypertension and Thromboembolism Among Transgender Patients Using Gender-Affirming Hormone Therapy.

Maria Pyra,Cori Blum,Kristin Keglovitz Baker,Laura Rusie,Nat Ross,Andie Baker,Isabel Casimiro,John Schneider

doi:10.1089/trgh.2019.0061

Maria Pyra, Cori Blum + Show 6 more

Open Access

https://doi.org/10.1089/trgh.2019.0061

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Abstract

Purpose: Given evidence from cisgender patients that sex hormones can impact risk for some forms of cardiovascular disease (CVD), there are concerns regarding CVD among transgender patients using gender-affirming hormone therapy (HT).Methods: Using a retrospective cohort at a U.S. urban federally qualified health center (FQHC) focused on sexual and gender minority health, we examined associations between HT in transgender patients and two specific CVD outcomes, hypertension (HTN) and thromboembolism (TE). We assessed outcomes by ICD-10 codes in electronic medical records (EMR) of 4402 transgender patients. Hormone use was assessed both by blood concentrations and by prescriptions, from EMR.Results: Nineteen transwomen (TW) (0.8%) had a TE and 49 (2.1%) developed HTN; among transmen (TM), 27 (1.5%) developed HTN and there were no significant associations between hormones and HTN. Among transwomen, there was no association between TE and HT as assessed by blood concentrations. However, recent progestin prescriptions were associated with an increased odds of TE (adjusted odds ratio [aOR] 2.95 [95% confidence interval; CI 1.02–8.57]), with possibly differential effects for medroxyprogesterone acetate versus micronized progesterone. Higher total testosterone blood concentrations were associated with greater odds of HTN in TW (aOR 1.16 [95% CI 1.01–1.33]), after controlling for body mass index. Among TW, ever having a progestin prescription was protective for HTN (aOR 0.36 [95% CI 0.15–0.87]).Conclusion: We found no associations between HT and HTN among TM, More research is needed to examine the effect of recent progestin, specifically medroxyprogesterone acetate, on TE among transwomen. The protective association between progestins and HTN among TW is reassuring.

Highlights

The goal of gender affirming hormone therapy (HT) is to suppress endogenous sex hormones and maintain sex hormone levels within the recommended range for the person’s affirmed gender.[1,2] Most of the research regarding the relationship between the use of sex hormones and cardiovascular disease (CVD) has been obtained from cisgender populations.[3,4,5] there are important differences in hormonal formulations, dosing, therapy duration, endogenous hormone exposure, and comorbidities between cisgender and transgender patients.[6]
Overall, we found a strong association that having a recent prescription for progestin increased the odds of TE nearly threefold among transwomen when adjusting for other hormone prescriptions, race, insurance, HIV status, and body mass index (BMI) (Table 5); this association may be stronger for medroxyprogesterone acetate (MPA) than progesterone
We found that endogenous levels of testosterone were associated with increased odds of HTN only when the model was adjusted for BMI

Summary

Introduction

The goal of gender affirming hormone therapy (HT) is to suppress endogenous sex hormones and maintain sex hormone levels within the recommended range for the person’s affirmed gender.[1,2] Most of the research regarding the relationship between the use of sex hormones and cardiovascular disease (CVD) has been obtained from cisgender populations (those whose gender identity aligns with their sex at birth).[3,4,5] there are important differences in hormonal formulations, dosing, therapy duration, endogenous hormone exposure, and comorbidities between cisgender and transgender patients.[6].

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