The effect of gender-affirming hormone therapy on the risk of subclinical atherosclerosis in the transgender population

Posted August 21, 2023

“Our team is already conducting another study, in which we assess heart rate variability using a heart test—Holter—at rest and after stress in transgender patients receiving GAHT compared with cisgender patients, which will probably help us understand a little more about the role of hormones on cardiovascular risk”, she concluded.

A systematic review conducted by the INCT Hormona team at Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil, evaluated the most recent evidence on risk factors for subclinical atherosclerosis in transgender people receiving gender-affirming hormone therapy (GAHT).  The article, titled “The Effect of Gender-Affirming Hormone Therapy on the Risk of Subclinical Atherosclerosis in the Transgender Population: A Systematic Review”, can be read in full at According to Dr. Roberta Moreira Allgayer, the main motivation for the study was the fact that the role of hormone therapy in the cardiovascular health of transgender patients is still unclear. “Cohort studies have shown that this population has a higher mortality rate from cardiovascular causes, however, since these are large studies that do not control for several risk factors, there is still doubt about the role of hormones in these outcomes,” she explained.  For the systematic review, the PubMed, LILACS, EMBASE, and Scopus databases were searched for cohort, case-control, and cross-sectional studies or randomized clinical trials including transgender people receiving GAHT.  Of 159 potentially eligible studies initially identified, 12 were included in the systematic review (8 cross-sectional and 4 cohort studies). “Our results indicated a possible increased risk of subclinical atherosclerosis in transgender men using testosterone, and a lower or neutral risk in transgender women using different formulations of estradiol and antiandrogens,” explained Dr. Allgayer. Despite these results, Dr. Allgayer explains that the evidence produced is not entirely conclusive. “Additional randomized controlled trials are needed to determine how the use of hormones affects cardiovascular parameters in this population”, she said.