Does Taking Testosterone Raise Risk Of Heart Attack In Transgender
Sex hormones for gender transitioning hike risk of stroke, heart attacks, study finds
Nearly 4,000 Dutch trans women and trans men given hormones during their gender transition had an elevated risk for strokes, heart attack and blood clots
As doctors consider how young is too young to give sex hormones to children who say they are transgender, more research is linking gender-affirming hormone therapy with an increased risk of strokes, blood clots and heart attacks.
A new analysis found that trans women — people born male who identify as female — on hormone therapy had more than twice as many strokes as women, and nearly twice as many strokes as men over the study period. Trans women also had five times as many deep-vein blood clots compared to non-trans women and men.
Trans men — those born female who identify as male — who received hormones had a three-fold higher risk of heart attack compared with women.
"In light of our results, we urge both physicians and transgender individuals to be aware of this increased cardiovascular risk," study author, Dr. Nienke Nota, of Amsterdam University Medical Center, said in a statement.
Still, Nota said the benefits of cross-sex hormone therapy outweigh the risks. For people who identify with the opposite gender, the pills, patches and injections can reduce the stress and trauma of watching their bodies evolve into the "wrong" sex.
Published this week in the journal Circulation, the paper comes as growing numbers of children and youth, convinced they were "assigned" the wrong gender at birth, are seeking medical treatment to begin the process of physically transitioning.
The hormones are a very important part of the lives of these people and, whether a young person or an adult, they need to understand the safety and the risks, and how they're going to be followed.
With wait-lists at specialty clinics in Canada stretching a year or longer, family doctors are being encouraged to support the social and medical transitioning of children and teens with "gender dysphoria" — the term for the distress that can accompany the mismatch between the gender one identifies with, and the one he or she was born with.
A recent review article published in the Canadian Medical Association Journal urges doctors to take a "thoughtful, affirming" approach when dealing with children and youth with gender dysphoria, and to avoid influencing teens to "move down a path they would not have chosen for themselves."
The article said puberty-suppressing drugs can be given once puberty starts, followed by cross-sex hormones around age 16 — or as young as 13-and-a-half in special circumstances.
However, concerns have been raised about the long-term effects of the hormones — testosterone for a trans man, and estrogen for a trans woman. In trans men, testosterone promotes beard and body hair growth and muscle bulk; the voice deepens and periods stop. Estrogen increases breast tissue and fat on the hips.
Hormone therapy has been linked with a higher risk of blood clots and heart attack in women taking it after menopause. Less known was the effects of hormones in people undergoing gender transition, Nota said.
"In light of our results, we urge both physicians and transgender individuals to be aware of this increased cardiovascular risk
The study involved nearly 4,000 Dutch people who received gender-transitioning hormones between 1972 and 2015.
The researchers looked at the medical records of 2,517 transgender women who received estrogen and 1,358 transgender men given testosterone. Trans women were followed for an average of nine years, and trans men for an average of eight.
The researchers counted up the number of "cardiovascular events" — heart attacks, strokes and deep-vein blood clots — and compared the cases to those reported in the general population. The median age hormone therapy was started was 30 for trans women, and 23 for trans men.
"In trans women (those who transitioned to female) we found a total of 132 cardiovascular events, while 70 were expected when using men as reference," Nota said in an email.
In transgender men (female to male) there were 11 heart attacks, while three were expected when using women as a reference.
The higher risks seem meaningful, Nota said.
However, the authors couldn't control for smoking, weight, diet or other risk factors, meaning they can't make a direct, cause-and-effect link. Prevalence rates of smoking were as high as 46 per cent. The risk of heart attack and stroke also decreased over time.
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Puberty blockers, cross-sex hormones: Canada's doctors get guidance on treating children with 'gender dysphoria'
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Who gets to decide when a 14-year-old wants to change gender? The child, the hospital, the battling parents?
However, a study last year found transgender women taking estrogen had higher levels of insulin and triglycerides — fat carried in the blood that can contribute to the build-up of plaque on artery walls. Estrogen can also make blood more prone to clotting, which may explain the higher rates of strokes and blood clots seen in the Dutch study.
The increased risk of heart attack in transgender men could be down to testosterone's tendency to make blood stickier by increasing the concentration of red blood cells and raising levels of LDL, or "bad" cholesterol.
People prescribed hormones should have their blood pressure and blood fats monitored regularly and adopt a healthy lifestyle — exercise, eat a healthy diet, no smoking — to reduce their risks, Nota said.
"(The study) doesn't mean that everyone who is taking the hormones for transition is going to have a heart attack," said Dr. Nieca Goldberg, a cardiologist and pioneer in women's heart health at NYU Langone Health in New York who wasn't involved in the study.
"But it should stimulate further research for us to understand the mechanisms, and for us to really dial down to those individuals who may be at the highest risk."
The study doesn't address cross-sex hormones in youth, and shouldn't be extrapolated to the young, Goldberg said.
"The hormones are a very important part of the lives of these people and, whether a young person or an adult, they need to understand the safety and the risks, and how they're going to be followed."
Everyone also needs to be aware of the signs of a heart attack, she said — including sudden tightness or pressure in the chest "that feels like an elephant is sitting on your chest" and that radiates to the arm, neck or jaw, extreme fatigue or shortness of breath.
National Post
• Email: skirkey@postmedia.com | Twitter: sharon_kirkey
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Does Taking Testosterone Raise Risk Of Heart Attack In Transgender
Source: https://nationalpost.com/health/sex-hormones-for-gender-transitioning-hike-risk-of-stroke-heart-attacks-study-finds
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