Hormone therapy for gender dysphoria associated with increased CV risk

People with gender dysphoria on hormone replacement therapy (HRT) as part of gender affirmation therapy have substantially increased odds of serious cardiac events and other problems, including ischaemic stroke, pulmonary embolism, ST-elevation myocardial infarction (STEMI), non-STEMI, drug abuse, and hypothyroidism.

Between 1 million to 1.6 million Americans identify as transgender, according to the study's first author Dr Ibrahim Ahmed (Mercy Catholic Medical Center, PA, USA) [1]. Among them, HRT use is rising rapidly, especially among teens and young adults. The aim of this retrospective study was 2-fold: to characterise the demographics of gender dysphoria patients using HRT and to study the impact of this therapy on cardiovascular(CV) outcomes in the setting of gender dysphoria, of which little is known. The researchers accessed the 2019 Nationwide Inpatient Sample database to identify admissions of adults diagnosed with gender dysphoria and the use of HRT. The primary outcome was CV events in HRT users versus non-users.

Of 21,335 identified gender dysphoria patients, 1,675 had used HRT. Compared with non-users, patients in the HRT cohort were slightly older (31 vs 34 years) and were less often women (47% vs 55%); race distribution was similar in the 2 groups.

HRT was significantly associated with:

1. ischaemic stroke: OR 7.15 (95% CI 2.74–18.67; P<0.001);
2. pulmonary embolism: OR 4.92 (95% CI 2.08–11.62; P<0.001);
3. STEMI: OR 5.90 (95% CI 1.07–32.42; P<0.05);
4. non-STEMI: OR 3.30 (95% CI 1.20–9.04; P<0.05).

HRT was not significantly associated with atrial fibrillation, diabetes mellitus, hypertension, haemorrhagic stroke, and systolic heart failure, Dr Ahmed added. The all-cause mortality rate in HRT users was similar: 0.60% versus 0.48% (P=0.774). The mean length of hospital stay was also similar (5.71 vs 6.09 days; P=0.321), as was the mean total hospitalisation charge ($61,012 vs $49,930; P=0.598).

“It's all about risks and benefits,” said Dr Ahmed. “Starting transitioning is a big part of a person's life and helping them feel more themselves, but HRT also has numerous side effects. It's not free of risk.” He added that “a careful risk-benefit discussion” should precede HRT in patients with gender dysphoria.

1. Ahmed I, et al. Cardiovascular outcomes in gender dysphoric patients undergoing hormone replacement therapy. Session 1068-05, ACC Scientific Session 2023, 4–6 March, New Orleans, USA.

 

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Posted on 7 June 202322 February 2024