Cardiometabolic impacts of gender-affirming hormone therapy in transgender persons: a systematic review

Introduction: Transgender persons with gender dysphoria can be treated using hormones based on estradiol and testosterone. The long-term cardiovascular effects of these therapies are not fully known. Objective: To verify the impact of gender-affirming hormone therapy on risk factors for cardiovascular events (lipid profile, glucose, and blood pressure) and cardiovascular events (acute myocardial infarction [AMI], stroke, and venous thromboembolism [VTE]) in transgender persons. Methods: A systematic review of scientific articles was performed using the PubMed/MEDLINE, Scopus, Embase, and Web of Science platforms. Results and Discussion: The search resulted in 1040 articles, of which 154 duplicates were discarded. Of the remaining 886, 837 articles were excluded, leaving 49, which were read in full. Among these, after confrontation of two researchers, 14 were selected for interpretation and final data extraction. Regarding the data obtained, 11 articles considered transgender women (TW), resulting in a population of 7154 people, with a mean age of 29 years. When interpreting the results, there was an increase in VTE and stroke events in TW compared to cis men and women. The cardiovascular risk factors did not show significant changes in the evaluated studies. Twelve studies were considered for transgender men (TM), generating a population of 4393 people, with a mean age of 26 years. A worsening of the lipid profile in TM and an increase in AMI were observed in comparison with cis women. Conclusion: Review data showed that transgender persons have a risk of increased cardiovascular outcomes and may require early intervention as a preventive measure.