Cardiometabolic Effects of Testosterone in Transmen and Estrogen Plus Cyproterone Acetate in Transwomen

• Published in: The journal of clinical endocrinology and metabolism Vol. 104; no. 6; pp. 1937 - 1947
• Main Authors: van Velzen, Daan M, Paldino, Alessia, Klaver, Maartje, Nota, Nienke M, Defreyne, Justine, Hovingh, G Kees, Thijs, Abel, Simsek, Suat, T’Sjoen, Guy, den Heijer, Martin
• Format: Journal Article
• Language: English
• Published: Washington, DC Endocrine Society 01.06.2019; Copyright Oxford University Press; Oxford University Press
• Subjects: Acetates; Acetic acid; Administration, Oral; Adolescent; Adult; Blood pressure; Blood Pressure - drug effects; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - prevention & control; Cholesterol; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Cyproterone acetate; Cyproterone Acetate - administration & dosage; Cyproterone Acetate - adverse effects; Estrogen; Estrogens; Estrogens - administration & dosage; Estrogens - adverse effects; Female; High density lipoprotein; Hormone Replacement Therapy - adverse effects; Hormone Replacement Therapy - methods; Hormones; Humans; Low density lipoprotein; Low density lipoproteins; Male; Phenols; Prospective Studies; Sex Factors; Sex Reassignment Procedures - adverse effects; Sex Reassignment Procedures - methods; Testosterone; Testosterone - administration & dosage; Testosterone - adverse effects; Transdermal medication; Transdermal Patch; Transgender people; Transgender Persons; Triglycerides; Triglycerides - blood; Young Adult; Belgium; Netherlands
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2018-02138

Abstract Context The impact of gender-affirming hormone therapy (HT) on cardiometabolic parameters is largely unknown. Objective The effects of 1 year of treatment with oral or transdermal administration of estrogen (plus cyproterone) and transdermal or IM application of testosterone on serum lipid levels and blood pressure (BP) were assessed in transgender persons. Design and Methods In this prospective, observational substudy of the European Network for the Investigation of Gender Incongruence, measurements were performed before and after 12 months of HT in 242 transwomen and 188 transmen from 2010 to 2017. Results Mean values are reported. In transmen, HT increased diastolic BP (2.5%; 95% CI, 0.6 to 4.4) and levels of total cholesterol (TC; 4.1%; 95% CI, 1.5 to 6.6), low-density lipoprotein–cholesterol (LDL-C; 13.0%; 95% CI, 9.2 to 16.8), and triglycerides (36.9%; 95% CI, 29.8 to 44.1); high-density lipoprotein–cholesterol levels decreased (HDL-C; 10.8%; 95% CI, −14.0 to −7.6). In transwomen, HT slightly decreased BP (systolic BP, −2.6%, 95% CI, −4.2 to −1.0; diastolic BP, −2.2%, 95% CI, −4.0 to −0.4) and decreased levels of TC (−9.7%; 95% CI, −11.3 to −8.1), LDL-C (−6.0%; 95% CI, −8.6 to 3.6), HDL-C (−9.3%; 95% CI, −11.4 to −7.3), and triglycerides (−10.2%; 95% CI, −14.5 to −5.9). Conclusion Unfavorable changes in lipid profile were observed in transmen; a favorable effect was noted in transwomen. HT effects on BP were negligible. Long-term studies are warranted to assess whether and to what extent HT in trans individuals results in a differential effect on cardiovascular disease outcomes. In this prospective observational study, favorable lipid changes were found in transwomen and unfavorable lipid changes found in transmen after 12 months of gender-affirming hormone therapy.