Baseline Risk Factors Contribute to Increased ASCVD Risk in Transgender Adolescents on Hormone Therapy

Nicole L. Mihalopoulos, MD, MPH

New research from the University of Utah suggests undergoing gender-affirming hormone therapy may not increase cardiovascular disease risk among transgender patients.

A retrospective chart review of 50 trans female and 50 trans male patients, results suggest an increased presence of risk factors at baseline could be driving the increased risk of atherosclerotic cardiovascular disease (ASCVD) seen among this patient population, but also indicate hormone therapy may have a negative impact on some ASCVD risk factors in trans male patients.

“Gender-affirming hormone therapy appears to have greater benefits than risks for transgender adolescents and young adults,” said lead investigator Nicole L. Mihalopoulos, MD, MPH, chief of the division of adolescent medicine at the University of Utah, in a statement. “For some people, these findings influence their decision to not to start gender-affirming hormones during adolescence. However, without gender-affirming hormone therapy, transgender individuals may experience worse gender dysphoria, depression, anxiety and possibly increased suicidal ideations.”

With previous observational data suggesting gender-affirming hormone therapy was associated with increased risk of cardiovascular disease in transgender patients, investigators sought to fill the knowledge gap related to this potential increase in risk. To do so, they designed the current study as a retrospective chart review of patients receiving gender-affirming hormone at the Adolescent Medicine Clinic at Primary Children’s Hospital in Salt Lake City from January 2015-December 2020.

The investigators' initial search returned a population of 300 transgender adolescents. Of these, 100 patients—50 trans female and 50 trans male—were randomly selected for inclusion in the final analyses. For the purpose of analysis, investigators assessed ASCVD risk parameters among these patients at baseline and 1 year after initiating hormone therapy.

Analysis of baseline data indicated at least one abnormal value was found among 50% of trans female and 66% of trans male patients. Investigators pointed out obesity was the abnormal value in 5 of the 25 trans female patients and 13 of the 33 trans male patients with an abnormal value for an ASCVD risk parameter at baseline.

At 1 year, at least one abnormal value was found among 30% of trans female patients and 70% of trans male patients. In paired t-tests, investigators found no significant change in ASCVD risk factors among trans female patients but noted a significant decrease in HDL and a significant increase in BMI among trans male patients.

Investigators noted multiple limitations within their study for clinicians to consider before overinterpretation of results. These limitations included the small sample size, most patients identifying as non-Hispanic White individuals, and limited follow-up period. Investigators also noted the need for future research to further understand the relationship between gender-affirming hormone therapy and ASCVD risk factors.

This study, "Transgender Adolescents Have High Prevalence of Atherosclerotic Cardiovascular Disease Risk Factors Before and After Taking Hormone Therapy For 1 Year,” was presented at the AHA EPI Lifestyle Conference 2021.