Hormonal Treatment Of Transgender Adolescents May Not Increase Cardiovascular Risk

Hormonal treatment of transgender adolescents does not appear to worsen their cardiovascular risk profiles, according to a retrospective study.

"There is ample evidence of the psychological benefits of suppressing puberty in transgender adolescents," Dr. Marianne van der Loos of Amsterdam University Medical Center told Reuters Health by email. "This study adds to the growing body of literature showing that this treatment protocol is safe in terms of cardiovascular risk factors and thus endorses the current guidelines on treatment of transgender adolescents."

There are currently very limited data regarding the potential cardiovascular side effects of treatment with gonadotropin-releasing hormone agonists (GnRHas) and gender-affirming hormones (GAHs) in transgender adolescents.

Dr. van der Loos and colleagues examined the effects of treatment with GnRHas followed by the addition of GAHs on changes in cardiovascular risk factors among 71 transwomen and 121 transmen diagnosed with gender dysphoria between 1998 and 2015.

These individuals started GnRHa treatment at a mean age of 15 years and GAH treatment at a mean age of 17 years.

By age 22 years, the prevalence of high total cholesterol levels was similar or lower in transwomen (0%) and transmen (5.3%) compared with reference women (6.6%) and men (4.4%), and the prevalence of low HDL cholesterol levels was only slightly higher in transwomen (2.9%) compared with reference women (0.0%).

Other changes in blood pressure, glucose, and lipid levels were similar or more favorable in transgender adolescents compared with their desired sex, the researchers report in Pediatrics.

The prevalence of obesity was higher in transgender adolescents than in reference adolescents at age 15 years, and this difference persisted at age 22 years, when the prevalence was 9.9% in transwomen and 6.6% in transmen versus 2.2% in reference women and 3.0% in reference men.

"Our study showed that fear of worsening cardiovascular risk factors by using GnRHa and subsequent gender-affirming hormones is ungrounded and should not" prevent health professionals from initiating treatment, Dr. van der Loos said. "However, caution is needed regarding body-weight management."

She added that long-term studies are needed to confirm the results. "Therefore, the start of endocrine treatment in transgender adolescents needs careful balancing of psychologic and somatic factors."

The study had no funding, and the authors report no conflicts of interest.

—Will Boggs MD

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