Abstract
Cardiovascular risk is increased in transgender persons using gender-affirming hormone therapy. To gain insight into the mechanism by which sex hormones affect cardiovascular risk in transgender persons, we investigated the effect of hormone therapy on markers of inflammation and hemostasis. In this exploratory study, 48 trans women using estradiol patches plus cyproterone acetate (CPA) and 47 trans men using testosterone gel were included. They were between 18 and 50 years old and did not have a history of cardiovascular events. Measurements were performed before and after 3 and 12 months of hormone therapy. After 12 months, in trans women, systemic and endothelial inflammatory markers decreased (hs-CRP -66%, (95% CI -76; -53), VCAM-1-12%, (95% CI -16; -8)), while platelet activation markers increased (PF-4 +17%, (95% CI 4; 32), β-thromboglobulin +13%, (95% CI 2; 24)). The coagulation marker fibrinogen increased transiently, after 3 months (+15%, (95% CI 1; 32)). In trans men, hs-CRP increased (+71%, (95% CI 19; 145)); platelet activation and coagulation markers were not altered. In both trans women and trans men, leptin and adiponectin changed towards reference values of the experienced gender. Platelet activation and coagulation marker concentrations increased in trans women using transdermal estradiol plus CPA, but not in trans men using testosterone. Also, concentrations of inflammatory markers decreased in trans women, while hs-CRP increased in trans men. Our results indicate that hormone therapy may affect hemostasis in transgender persons, which could be an underlying mechanism explaining the increased cardiovascular risk in this population.
Highlights
Transgender persons experience an incongruence between their sex assigned at birth and their gender identity
After 12 months, in trans women, systemic and endothelial inflammatory markers decreased (hs-CRP -66%, vascular adhesion molecule 1 (VCAM-1)–12%,), while platelet activation markers increased (PF-4 +17%, β-thromboglobulin +13%,)
In trans women, hormone treatment consists of estrogens, often in combination with antiandrogens
Summary
Transgender persons experience an incongruence between their sex assigned at birth and their gender identity. Transgender persons can receive gender-affirming hormone therapy (GAHT) as part of their transition. In trans women (male sex assigned at birth, female gender identity), hormone treatment consists of estrogens, often in combination with antiandrogens (in Europe usually cyproterone acetate, CPA). In trans men (female sex assigned at birth, male gender identity), hormone treatment consists of testosterone [1]. Previous studies have shown that both trans women and trans men receiving hormone therapy have an increased risk of cardiovascular events compared to the general population [2, 3]. Trans women have an increased risk of stroke, myocardial infarction, and venous thromboembolism. Trans men seem to have an increased risk of stroke and myocardial infarction [4, 5]. Cardiovascular risk is increased in transgender persons using gender-affirming hormone therapy. To gain insight into the mechanism by which sex hormones affect cardiovascular risk in transgender persons, we investigated the effect of hormone therapy on markers of inflammation and hemostasis
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