Summary of Hormone Replacements for Gender Affirmation Therapy May Raise Risk of Heart Attack and Stroke:
Individuals with gender dysphoria undergoing hormone replacement therapy as part of gender affirmation therapy are at a higher risk of experiencing serious cardiac events such as stroke, heart attack, and pulmonary embolism, according to a study. The study, presented at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology, recommends enhanced screening and counseling prior to commencing therapy. Gender affirmation therapy helps individuals who identify as transgender to acquire secondary sex characteristics that align with their gender identity. Recent estimates suggest one million to 1.6 million people identify as transgender in the US, and hormone therapy use is rising rapidly, particularly among young adults.
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Gender Dysphoria Patients Under Hormone Replacement Therapy at Higher Risk for Cardiac Events
Gender identity conflict with sex assigned at birth is called gender dysphoria. Gender affirmation therapy (GAT) includes behavioral, psychological, and medical interventions to help individuals acquire secondary sex characteristics that align with their gender identity. Hormone replacement therapy (HRT) is an essential component of GAT, but new research shows that individuals with gender dysphoria who undergo hormone replacement therapy as part of gender affirmation therapy are at a significantly higher risk of experiencing serious cardiac events such as stroke, heart attack, and pulmonary embolism.
Increased Cardiovascular Risks
According to a new study presented at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology, people with gender dysphoria who have taken hormone replacements as part of their GAT have a substantially increased risk of serious cardiac events, including stroke, heart attack, and pulmonary embolism. Researchers suggest the need for enhanced screening and counseling before starting therapy.
Historically, the transgender population has been understudied, and previous research on hormone-modulating medications has primarily focused on younger women using hormone-based birth control or on older women following a hysterectomy, or during menopause. The current study, however, is the largest to date examining the cardiovascular risks of gender affirmation therapy in people with gender dysphoria who have undergone HRT.
Retrospective Study
The study retrospectively examined rates of cardiovascular events in over 21,000 people with gender dysphoria from a national hospital database, of whom 1,675 underwent HRT. Usually, people assigned male at birth receive estrogen, and people assigned female at birth receive testosterone. The overall results found that hormone replacements were associated with higher rates of cardiac events, mostly related to dangerous blood clots. However, no association between hormone replacement therapy and higher rates of death was found.
“This study is all about risks and benefits. Starting transitioning is a significant part of a person’s life and helps them feel more like themselves. Still, hormone replacement therapy also has a lot of side effects; it’s not risk-free,” says Ibrahim Ahmed, MD, a third-year resident at Mercy Catholic Medical Center in Darby, Pennsylvania and the study’s lead author.
Increased Risk Factors
In the study, people with gender dysphoria who had ever used hormone replacements saw nearly seven times the risk of ischemic stroke (a blockage in a vessel supplying blood to the brain), nearly six times the risk of the most serious type of heart attack called ST elevation myocardial infarction, and nearly five times the risk of pulmonary embolism, a blockage in an artery in the lung, compared with people with gender dysphoria who had never used hormone replacements.
Both estrogen and testosterone increase the clotting activity of blood, which could explain the increase in clotting-related cardiovascular events. Those taking hormone replacement therapy also had higher rates of substance use disorder and hypothyroidism.
Limitations
One limitation of the study is that it only accounted for whether individuals had ever used any type of hormone replacement therapy. To better inform clinical decisions, researchers said it would be helpful to assess whether the duration of treatment, the age at which it is initiated, or the type of hormone therapy used affects the risks. Ahmed said, “Looking at a person’s medical and family history should definitely be part of the screening protocol before they even start hormone replacement therapy. It is also important that people considering this therapy are made aware of all the risks.”
Continued Study on Gender Affirmation Therapies
People should consider ways to mitigate potential cardiovascular risks before starting hormone replacement therapy for individual patients. It is also important to continue to study potential long-term cardiovascular and other health effects of gender affirmation therapies as the use of these therapies become more common. Around 1 million to 1.6 million people identify as transgender in the U.S., and hormone therapy use is rising rapidly, especially among teens and young adults.
Ahmed is presenting the study, “Cardiovascular Outcomes in Gender Dysphoric Patients Undergoing Hormone Replacement Therapy,” on Sunday, March 5, 2023, at 2:30 p.m. CT / 20:30 UTC, in the Prevention and Health Promotion Moderated Poster Theater 10, Hall F.
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