Lipid profiles and hypertriglyceridemia among transgender and gender diverse adults on gender-affirming hormone therapy

Abstract

BackgroundThe effects of gender-affirming hormone therapy on lipid profiles among transgender adults have been inconsistent and incompletely characterized. ObjectiveTo longitudinally assess changes to lipid profiles following hormone therapy and to establish prevalence rates of hyperlipidemia/low HDL-cholesterol. MethodsThis longitudinal study followed lipid profiles of 366 transgender and gender-diverse adult patients (170 transfeminine and 196 transmasculine; mean age, 28 years) in Washington DC USA. Lipid profiles were measured at baseline and at multiple follow-up clinical visits up to 57 months after the initiation of hormone therapy. ResultsWithin 2–10 months of starting gender-affirming hormone therapy, mean levels of HDL-cholesterol decreased by 16% in transmasculine individuals and increased by 11% in transfeminine individuals. Over the study, mean triglyceride levels increased by 26–37% in the transmasculine group. Over the study, the prevalence of moderate hypertriglyceridemia (175–499 mg/dL) ranged from 11 to 32% in the transfeminine group and 6–19% in the transmasculine group. Severe hypertriglyceridemia (≥500 mg/dL) was only observed in one individual. On hormone therapy, 24–30% of the transfeminine group had a HDL-cholesterol < 50 mg/dL and 16–24% of the transmasculine group had a HDL-cholesterol < 40 mg/dL. LDL-cholesterol levels ≥160 mg/dL were rare among both groups. ConclusionsIn a gender-diverse population on hormone therapy, low HDL-cholesterol and moderate hypertriglyceridemia were relatively common. HDL-cholesterol decreased with testosterone therapy and increased with a combination of oral estrogen and spironolactone. Testosterone use was associated with an increase in triglycerides. Our data support the recommendation to routinely monitor lipid profiles in gender-diverse patients on GAHT.