DOES GENDER-AFFIRMING HORMONAL THERAPY CAUSE A SIGNIFICANT RISE OF BLOOD PRESSURE IN YOUNG TRANSGENDER PEOPLE?

Abstract

Objective: Treatment of male transgender people with testosterone might raise BP (attributed to sodium/water retention), however the available literature is inconclusive. Treatment with estradiol plus androgen blockade has not usually been associated with increased BP. Design and method: Retrospective review of the subjects’ clinical records and the relevant literature. All included subjects gave their consent. People who started gender-affirming therapy after 30 or had antihypertensive treatment at baseline were excluded. Results: We obtained BP, height, body weight and medication use from 276 male and 259 female transgender people, before and 3–4 months after initiation of testosterone or estradiol (53 of the male and 35 of the female subjects had previously used LHRH agonists). The SBP of male transgender people was raised by 1.3 ± 2.8 and DBP by 0.6 ± 2.5 mmHg after testosterone initiation. This increase was not significant (paired t-test), and in bivariate analysis, mean BP was not significantly correlated to age, baseline BMI, change in body weight or testosterone dosage. The SBP of female transgender people changed by 2.7 ± 3.1 and DBP by 0.6 ± 2.5 mmHg after estradiol initiation. This change was significant for SBP (p = 0.043) but not for DBP (p = 0.078). Mean BP was not significantly correlated to age, baseline BMI, or estradiol dosage. However it correlated positively with change in body weight (Pearson’s r = 0.129, p = 0.026). The choice of androgen blocker was also relevant, with unchanged SBP in the 29 subjects who remained with LHRH agonists during estradiol initiation, but significantly increased (3.5 ± 4.0 mmHg, p = 0.012) in the 168 subjects who received cyproterone acetate along with estradiol, and significantly reduced in the 61 subjects who received spironolactone (-3.2 ± 2.5 mmHg, p = 0.028). Conclusions: The BP increase associated with testosterone initiation in male transgender subjects is very small in our experience and hardly relevant from a clinical point of view, except for occasional individuals with significantly raised BP. However estradiol initiation was often accompanied with increased SBP and body weight. The use of cyproterone acetate was also associated with increased BP, and is known to increase the thromboembolic risk (and rarely of meningioma) suggesting that LHRH blockade or spironolactone may be safer alternatives.