A new narrative review authored by Carl Streed Jr., MD, at Brigham and Women's Hospital, published in the Annals of Internal Medicine, discusses how more research is needed to better understand cardiovascular disease (CVD) and CVD risk factors in transgender patients receiving long term cross-sex hormone therapy.
Researchers at BWH and Johns Hopkins Hospital reviewed 13 studies on the effect of cross-sex hormone therapy on CVD among transgender persons. In transgender men, cross-sex hormone therapy was associated with worsening cardiovascular risk factors, such as increased blood pressure and insulin resistance. In transgender women, cross-sex hormone therapy increased potential thromboembolic risk. For both transgender men and women, the researchers say it is critical to reduce cardiovascular risk factors to prevent CVD, but especially in older transgender women.
According to the authors, cross-sex hormone therapy is associated with potential risks, but its psychosocial benefits cannot be denied. Use of cross-sex hormone therapy requires continued, shared decision making between patients and clinicians. To evaluate the difference among various cross-sex hormone therapy regimens, they note future research should be based on large prospective cohort studies that include cisgender men and women, transgender men and women receiving cross-sex hormone therapy, and transgender men and women not receiving cross-sex hormone therapy.