Exploring Cardiovascular Risks Among Transgender Individuals

Introduction:

Depathologization initiatives and more easily accessible medical treatment have contributed to a significant surge in transgender healthcare in several nations. They are requesting to begin taking gender-affirming hormones (GAHs) at a younger and younger age. Several detrimental adverse events, including myocardial infarction, stroke, and venous thromboembolism, have been documented in the literature after the administration of gender-affirming hormones. Transgender women who take estrogen probably have a higher chance of developing CVE (cardiovascular events); however, there is conflicting evidence about transgender men and their risk of developing CVE.

What Is Gender Affirming Hormone Therapy?

Some transgender people utilize gender-affirming hormone therapy to help their bodies more closely match their gender identification. To bring a person's physical appearance more closely in line with their gender identification, gender-affirming hormones are administered. It is the most popular route for transgender, non-binary, and gender-expansive individuals seeking gender-affirming medical care. Hormone therapy can be combined with or separate from gender-affirming surgery.

It is important to note that gender-affirming medications and surgery are not prerequisites for transgender identity; rather, they are medical alternatives open to those who would feel most authentic and validated in their bodies after undergoing these alterations. Usually, this entails taking estrogen or testosterone. Hormone therapy recipients who identify as transgender must undergo ongoing hormone level monitoring.

Transgender people use gender-affirming hormone therapy, usually with cross-sex hormones, as a key tactic to acquire the physical characteristics that correspond with their gender identity. Transgender women and men who wish to achieve feminization and masculinization physically are given estrogens and androgens, typically for an extended period. It is unclear whether giving cross-sex hormones to transgender individuals raises their risk of dying from CVE or worsening their lipid profiles.

It is crucial to decide whether to begin, adjust, or cease using hormones that promote gender identity. It is important to know how gender-affirming hormones may affect the body.

• Talk to the provider about body, mind, or fertility changes.

• Recognize the alterations that can be undone and those that cannot.

• Be reasonable when anticipating hormones that promote gender identity. Certain changes can take months or years to manifest, and each person's experience will differ.

• Make time for routine follow-up consultations to monitor the health and any changes in gender-affirming hormone levels.

• Hormones that promote gender identity can be administered as a tablet, injection, cream, or patch. Talk with the provider about which option best suits the goals and medical history.

What Are Different Gender Affirming Hormones?

• Gender-Affirming Hormones: Estrogen and Testosterone Blockers - To increase "feminine" secondary sex characteristics like breast growth, body fat redistribution to the hips and thighs, muscle mass loss, and possible thinning or slowing of facial and body hair growth, transgender women, non-binary people, and transfeminine gender expansive people may be interested in taking testosterone blockers or estrogen.

• Gender Affirming Hormone: Testosterone - To enhance "masculine" secondary sex traits like developing a deeper voice, shifting body fat away from the hips and thighs, growing facial and body hair, building muscle mass, and altering menstrual cycles, transgender men, non-binary people, and transmasculine gender-expansive people may be interested in taking testosterone.

Please be aware that every person is affected by gender-affirming hormones differently, and one cannot select the changes they may experience.

What Steps Can Transgender People Take to Minimize the Risk of Heart Disease?

Being transgender may put people at greater risk for circulatory and cardiac issues. Here are a few strategies to lower the risk:

• Get a health checkup that includes a blood pressure check based on the results and the treatments the person receives.

• Undergo regular health checkups.

• Ensure that the physician routinely checks the hormone levels.

• Smoking can cause artery blockages, which increases the risk of heart attacks and strokes.

• If one smokes, get advice on how to stop smoking or ask a doctor about resources that may be of help.

• Have a cholesterol test done if heart issues run in the family.

• Seek assistance for stressful topics like discrimination or the rights of a transgender person.

• Keep an eye on how much alcohol consumption and manage drinking. Reducing costs can have an impact as well.

Is There an Increased Risk of Heart Attack or Stroke Among Transgender Individuals?

Heart attacks and strokes are more common in transgender individuals, whether or not they use hormone therapy. Even after controlling for other risk factors, transgender people had a higher claimed history of heart attacks than cisgender people (those whose gender identity corresponds with the actual sex they were born with). Social forces and stigma are probably partially at fault for this. Discrimination raises the risk of unhealthy habits like smoking. Therefore, transgender people must receive inclusive access to health services like blood pressure checks and stop-smoking programs.

Are There Any Connections Between Gender-Affirming Hormone Therapy and Cardiovascular Issues?

Concerns have been raised regarding a potential association between gender-affirming hormone therapy and an increased risk of heart and circulation issues, including a probable relationship between blood clots and dyslipidemia (high blood fat). While trans men did have higher levels of cholesterol and blood pressure, the researchers did not uncover any evidence linking trans women to an increased risk of heart attacks or strokes. Gender-affirming hormone therapy may raise blood pressure in transgender men and women, according to certain research.

Conclusion:

Regardless of the kind of treatment, a study found that transgender patients receiving hormone therapy had a higher chance of death. Over time, there was no decline in this elevated risk of mortality. The cause-specific mortality risk of cardiovascular disease (CVD) suggests that medical morbidities and lifestyle factors should still be monitored, optimized, and treated if needed. It does not point to a particular impact of hormone therapy.