Undergoing hormone therapy may raise the risks of heart disease and stroke among transgender people, a new study suggests.
The number of people who are transgender and who undergo surgery and hormone therapies to transition has increased sharply in recent years – particularly in the US.
Transitioning has many measurable benefits, including alleviating gender dysphoria for 80 percent of people who undergo the changes, improving their sex lives and overall quality of life.
But introducing higher levels of sex hormones is not without its risks, including raising the risks of heart attacks, strokes and blood clots by as much as two-fold, a new Amsterdam University study found.
Heart attacks, strokes and blood clots may be up to twice as common among transgender people as they are among the general population, new research finds
Trans men and women face an onslaught of social pressures, stigmas and prejudices that simply surpass what most of the population is subjected to.
Family rejection, bullying and feelings that their bodies don’t match who they are haunt transgender individuals disproportionately.
And for this reason, transgender children and teens are at vastly greater risks of attempting suicide than are their counterparts whose identities align with the gender they were assigned at birth.
About half of all transgender teenagers that were assigned female at birth but identify as male have attempted suicide, as have about 30 percent of teens assigned male but who identify as female.
Some 40 percent of teenagers that don’t strictly identify with either gender have attempted suicide, a recent University of Arizona study found.
Transitioning, on the other hand, has been shown to bring all manner of mental health and social benefits to trans people.
Transitioning can consist of hormonal and surgical components – usually in that order – to help trans men and women modify their bodies to reflect their identities.
Surgeries to remove breasts and construct male genitalia for trans men, or to construct breasts and female genitalia for trans women are more invasive, but hormone therapies trigger more global changes within the body.
From research on post-menopausal women on hormone therapies, we’ve long known that introducing additional hormones comes with some complications are risks, but hormonal transitions are still a new enough medical development that there is little research on their long-term consequences.
To measure how testosterone and estrogen injections therapies for trans men and women, respectively, alter heart risks, the study, conducted by the Amsterdam University Medical Center, followed 2,517 trans women and 1,358 trans men from the Netherlands over the course of nearly a decade.
Trans women who received estrogen therapy had over twice as many strokes as cis women over the course of nine years, and just short of twice as many strokes as cis men.
Clots were also five times more common among trans women than cis women, and almost as much more common than they were among cis men.
Trans women also had far more heart attacks than did cis women, with rates tripling among those who had transitioned.
Certainly, trans people face social stresses that in and of themselves place greater pressure on the cardiovascular system.
Plus, those hardships are often associated with other behaviors that are bad for heart health.
‘In light of our results, we urge both physicians and transgender individuals to be aware of this increased cardiovascular risk,’ said first study author Dr Nienke Nota, an endocrinologist at the Amsterdam University Medical Center.
‘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.’
The new study didn’t attempt to find out why trans and cis people face such different risks, but, based on prior research, the team had some notion of what may have been at play.
Testosterone – taken to facilitate a female-to-male transition – is known to have a thickening effect on the blood.
The more viscose, sluggish blood is richer in red blood cells. It also tends to be higher in bad cholesterol and lower in good cholesterol – all of which make blood stickier, and harder for the heart to pump.
Trans women take estrogen, which is known to raise risks of blood clots and cause inflammation of the blood vessels, putting veins and arteries in greater danger of becoming blocked off.
The researchers advise that, given the benefits of transitioning, trans men and women should keep close track of their heart health, and modify the lifestyle factors that they can to offset the risks introduced by hormone therapy.