Cross-sex hormone therapy raises risk for vascular events in transgender women

1. Transgender women had higher rates of venous thrombotic events (VTE) with cross-sex hormones.

2. Similar rates of ischemic stroke and myocardial infarction were found among cisgender and transgender persons.

Evidence Rating Level: 2 (Good)

Study Rundown: Acute cardiovascular events are an important area of research with respect to transgender health and the process of medical treatment during transitioning. Hormone use may increase rates of ischemic stroke, VTE, and myocardial infarction. The authors of this study aimed to evaluate the incidence of these events in a group of transgender persons. Generally, it was found that cross-sex hormone therapy raises the risk for vascular events in transgender women. Participants were included from Kaiser Permanente in Georgia and northern and southern California. The main limitation of this study, however, was that the authors could not determine which transgender members received hormones outside of the Kaiser Permanente setting. This point limited further subgroup analyses within the study. Overall, study results suggested that further and more vigilant monitoring of cardiovascular risk factors in transgender women may be important for reducing vascular events.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Effects of Cross-Sex Hormone Treatment on Transgender Women and Men

In-Depth [retrospective cohort]: The authors conducted an electronic medical record-based cohort study with patients from 2006 to 2014. Ten male and ten female cisgender enrollees were matched to transgender participants based on terms of patient characteristics. Overall, a total of 2842 transfeminine and 2118 transmasculine members were included in this study. The authors found few differences in ischemic stroke and myocardial infarction amongst all groups analyzed in the study. However, it was observed that transgender women had higher rates of VTE compared to cisgender men and cisgender women. Specifically, the 2- year risk differences were 4.1 (95% CI, 1.6 to 6.7) and 3.4 (CI, 1.1 to 5.6) per 1000 persons relative to cisgender men and women, respectively.

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