Abstract
Objectives:Gender-affirming hormone therapy (GHT) is utilized by people who are transgender to align their secondary sex characteristics with their gender identity. Data relating to cardiovascular outcomes in this population are limited. We aimed to review the impact of GHT on the blood pressure (BP) of transgender individuals.Methods:We searched PubMed/MEDLINE, SCOPUS and Cochrane Library databases for articles published relating to the BP of transgender adults commencing GHT. Methodological quality was assessed via the ‘Quality Assessment Tool for Before–After (Pre–Post) Studies with No Control Group’.Results:Six hundred articles were screened, of which 14 studies were included in this systematic review encompassing 1309 individuals (∼50% transgender men and women) treated with GHT between 1989 and 2019. These articles were all pre–post observational studies without control groups. Mean ages ranged between 23.0–36.7 years (transgender men) and 25.2–34.8 years (transgender women). Interventions were diverse and included oral, transdermal and injectable hormonal preparations with 4 months to 5 years follow-up. Most studies in transgender men did not demonstrate a change in BP, whereas transgender women on GHT demonstrated both increases and decreases in SBP. These studies were heterogenous with significant methodological limitations and only two were determined to have a good quality rating.Conclusion:There is currently insufficient data to advise the impact of GHT on BP in transgender individuals. Better quality research is essential to elucidate whether exogenous sex hormones modulate BP in transgender people and whether this putative alteration infers poorer cardiovascular outcomes.
Highlights
Transgender people experience gender dysphoria due to incongruence between their gender identity and the sex they were assigned at birth [1]
Due to a paucity of epidemiological and mechanistic data, there is considerable uncertainty surrounding the impact of Genderaffirming hormone therapy (GHT) on the cardiovascular health of transgender individuals [5,6,7]
Many transgender individuals receiving GHT may be gender non-binary, and may not consider themselves as men or women [3]
Summary
Transgender people experience gender dysphoria due to incongruence between their gender identity and the sex they were assigned at birth [1]. Genderaffirming hormone therapy (GHT), including testosterone, estrogen, gonadotropin-releasing hormone (GnRH) analogues and antiandrogens, aims to align the characteristics of transgender people with their gender identity [1]. The recent substantive increases in population prevalence of transgender people requires the implementation of evidence-based guidance to better protect the health of this population [2,3,4]. Due to a paucity of epidemiological and mechanistic data, there is considerable uncertainty surrounding the impact of GHT on the cardiovascular health of transgender individuals [5,6,7]. Existing data suggest that the use of estrogens in transgender women confers an increased risk of myocardial infarction and ischemic stroke. Transgender men receiving testosterone lack any consistent evidence of an increased risk of cardiovascular or cerebrovascular disease [7]. In the absence of randomized controlled trials or comprehensive prospective longitudinal studies, ambiguity remains regarding whether such risk exists, and by which interventions this risk can be ameliorated
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