ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Pediatrics. 2020, Mar; 145. doi: https://pediatrics.aappublications.org/content/pediatrics/145/3/e20190741.full.pdf

Cardiovascular health of transgender people was a hot topic in the transgender literature last year, triggered by previous findings that these individuals could have elevated risks for cardiovascular diseases because of socioeconomic risk factors and unfavorable health behaviors.

This study investigated the combined effect of puberty suppression and hormonal treatment in 192 Dutch transgender adolescents on cardiovascular disease risk factors, by following them from start of gonadotropin-releasing hormone (GnRH) agonist treatment (mean age 15 years) to age 22 years. Changes over time in blood pressure, insulin resistance and lipid profile were similar to cisgender peers, but young transgender persons were more often obese. Novel findings from the US complemented these results, suggesting that body fat and lean tissue of both 19 transgender male and 13 transgender female adolescents under sex-affirming hormone treatment lies in between those of cisgender females and cisgender males (1).

In transgender adults, cardiovascular disease risk seemed to increase mainly in transgender men undergoing testosterone treatment: A prospective European multicenter study found unfavorable lipid profiles in 188 transmen after one year of hormone treatment (2), but not in transwomen. Endothelial function was impaired in 11 testosterone-treated US American transgender men, however transwomen were not studied (3). Finally, a cross-sectional study with a large random sample obtained from the US Centers for Disease Control and prevention (CDC) found that transgender women and men had a 2 and 4-fold increased odds for myocardial infarction compared to cisgender peers, after adjusting for age, race, chronic diseases and health behaviors (4).

Good weight management to lower obesity in transgender adolescents seems important to improve cardiovascular health later in life, in particular in transgender men, who seem to be especially vulnerable to cardiovascular disease.

References:

1. Body Composition and Markers of Cardiometabolic Health in Transgender Youth Compared With Cisgender Youth. Nokoff NJ, Scarbro SL, Moreau KL, Zeitler P, Nadeau KJ, Juarez-Colunga E, Kelsey MM. J Clin Endocrinol Metab. 2020, Mar 1; 105: e704–14; DOI 10.1210/clinem/dgz029, PMID 31544944. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112978/.

2. Cardiometabolic Effects of Testosterone in Transmen and Estrogen Plus Cyproterone Acetate in Transwomen. van Velzen DM, Paldino A, Klaver M, Nota NM, Defreyne J, Hovingh GK, Thijs A, Simsek S, T’Sjoen G, den Heijer M. J Clin Endocrinol Metab. 2019, Jun 1; 104: 1937–47; DOI 10.1210/jc.2018-02138, PMID 30602016. https://www.ncbi.nlm.nih.gov/pubmed/30602016.

3. Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population. Alzahrani T, Nguyen T, Ryan A, Dwairy A, McCaffrey J, Yunus R, Forgione J, Krepp J, Nagy C, Mazhari R, Reiner J. Circ Cardiovasc Qual Outcomes. 2019, Apr; 12: e005597; DOI 10.1161/CIRCOUTCOMES.119.005597, PMID 30950651. https://www.ncbi.nlm.nih.gov/pubmed/30950651.

4. Compromised endothelial function in transgender men taking testosterone. Gulanski BI, Flannery CA, Peter PR, Leone CA, Stachenfeld NS. Clin Endocrinol (Oxf). 2020, Feb; 92: 138–44; DOI 10.1111/cen.14132, PMID 31765022. https://www.ncbi.nlm.nih.gov/pubmed/31765022