Sex steroids affect cardiovascular outcomes in transgender individuals
Sex steroid therapy appears to elevate low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels and reduce high-density lipoprotein cholesterol (HDL-C) levels in female-to-male (FTM) individuals, while oral oestrogens appear to increase TG levels in male-to-female (MTF) individuals, suggests a study with low-quality evidence. Moreover, data on significant patient outcomes are still lacking.
Researchers conducted a comprehensive search of several databases up to 7 April 2015 for studies evaluating the effect of sex steroid use on lipids, myocardial infarction, stroke, venous thromboembolism (VTE) and mortality in transgender individuals. A random-effects model was used to pool weighted mean differences and 95 percent confidence intervals (CIs).
A total of 29 studies with moderate risk of bias met the inclusion criteria. Sex steroid in FTM individuals correlated with statistically significant increases in serum TG levels at 3 to 6 months and at ≥24 months (21.4 mg/dL; 95 percent CI, 0.14 to 42.6) and in LDL-C levels at 12 and ≥24 months (17.8 mg/dL; 3.5 to 32.1). There was a significant reduction in HDL-C levels across all follow-up periods (highest at ≥24 months, −8.5 mg/dL; −13.0 to −3.9).
Serum TG levels were significantly greater in MTF individuals at ≥24 months (31.9 mg/dL; 3.9 to 59.9) without any changes in other parameters. There were few reports of myocardial infarction, stroke, VTE and death events, and these more frequently occurred among MTF individuals.
“Transgender individuals receive cross-sex hormonal therapy to induce desired secondary sexual characteristics despite limited data regarding its effects on cardiovascular health,” according to researchers.