Available online 2 January 2023
Author links open overlay panel, , , , AbstractObjectiveThe impact of gender-affirming hormone therapy (GAHT) on cardiovascular (CV) health is still not entirely established. A systematic review was conducted to summarize the evidence on the risk of subclinical atherosclerosis in transgender people receiving GAHT.
MethodsA systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data were searched in PubMed, LILACS, EMBASE, and Scopus databases for cohort, case-control, and cross-sectional studies or randomized clinical trials, including transgender people receiving GAHT. Transgender men and women before and during/after GAHT for at least 2 months, compared with cisgender men and women or hormonally untreated transgender persons. Studies reporting changes in variables related to endothelial function, arterial stiffness, autonomic function, and blood markers of inflammation/coagulation associated with CV risk were included.
ResultsFrom 159 potentially eligible studies initially identified, 12 were included in the systematic review (8 cross-sectional and 4 cohort studies). Studies of trans men receiving GAHT reported increased carotid thickness, brachial-ankle pulse wave velocity, and decreased vasodilation. Studies of trans women receiving GAHT reported decreased interleukin 6, plasminogen activator inhibitor-1, and tissue plasminogen activator levels and brachial-ankle pulse wave velocity, with variations in flow-mediated dilation and arterial stiffness depending on the type of treatment and route of administration.
ConclusionsThe results suggest that GAHT is associated with an increased risk of subclinical atherosclerosis in transgender men but may have either neutral or beneficial effects in transgender women. The evidence produced is not entirely conclusive, suggesting that additional studies are warranted in the context of primary prevention of CV disease in the transgender population receiving GAHT.
Systematic Review RegistrationPROSPERO, identifier CRD42022323757.
Key words:transgender people
gonadal steroids
testosterone
estrogens
cardiovascular risk
atherosclerosis
AbbreviationsbaPWVbrachial-ankle pulse wave velocity
CEEconjugated equine estrogen
CIMTcarotid intima-media thickness
CVDcardiovascular disease
DCdistensibility coefficient
FMDflow-mediated dilation
FMD-NTGnitroglycerin-induced flow-mediated dilation
GAHTgender-affirming hormone therapy
PAI-1plasminogen activator inhibitor-1
tPAtissue plasminogen activator
View full text© 2023 AACE. Published by Elsevier Inc. All rights reserved.
留言 (0)