Hormone therapy increases risk for stroke, VTE in transgender women
Transgender women who received hormone therapy had an increased incidence of venous thromboembolic events and stroke compared with men and women not receiving hormone therapy, according to a study published in Circulation.
Martin den Heijer, MD, PhD, professor of internal medicine at Vrije University in Amsterdam, and colleagues analyzed data from 2,517 transgender women (median age, 30 years) and 1,358 transgender men (median age, 23 years) who were receiving hormone therapy. The hormone therapies included in this study were testosterone for transgender men and estrogen with or without antiandrogens in transgender women.
Transgender women were followed up for a mean of 9.07 years, and transgender men were followed up for a mean of 8.1 years.
Compared with reference women and men, transgender women had a higher adjusted incidence of VTE (standardized incidence ratio [SIR] for women = 5.52; 95% CI, 4.36-6.9; SIR for men = 4.55; 95% CI, 3.59-5.69) and stroke (SIR for women = 2.42; 95% CI, 1.65-3.42; SIR for men = 1.8; 95% CI, 1.23-2.56). The risk for MI was higher in both transgender women (SIR = 2.64; 95% CI, 1.81-3.72) and transgender men (SIR = 3.69; 95% CI, 1.94-6.42) compared with reference women.
Because ethinylestradiol may be the cause for an increased CV risk in transgender women, researchers performed subanalyses that excluded transgender women who started hormone therapy before 2001. SIRs in this population were not lower compared with the ratios of patients in the total population.
“In light of our results, we urge both physicians and transgender individuals to be aware of this increased cardiovascular risk,” Nienke Nota, MD, researcher in the department of endocrinology at Amsterdam University Medical Center, said in a press release. “It may be helpful to reduce risk factors by stopping smoking, exercising, eating a healthy diet and losing weight, if needed, before starting therapy, and clinicians should continue to evaluate patients on an ongoing basis thereafter.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.