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Is cardiovascular disease risk in transgender, gender-diverse, and non-binary adults associated with autonomic

Keila Turino Miranda1, Brittany K Schwende1, Alicia Duval2

  • 1Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.

Autonomic Neuroscience : Basic & Clinical
|May 15, 2025
PubMed

Insights

Transgender, gender-diverse, and non-binary adults may face higher cardiovascular disease risk due to autonomic nervous system imbalance. Understanding TGD-specific factors is crucial for improving cardiovascular health and affirming care.

Area of Science:

  • Cardiovascular physiology
  • Endocrinology
  • Public health

Background:

  • Chronically high blood pressure increases cardiovascular disease (CVD) risk.
  • Transgender, gender-diverse, and non-binary (TGD) adults exhibit higher blood pressure and CVD risk than cisgender adults.
  • Mechanisms for elevated blood pressure in TGD adults are unclear, hindering TGD-affirming healthcare.

Purpose of the Study:

  • To explore the association between cardiovascular disease risk in TGD adults and autonomic nervous system (ANS) imbalance.
  • To investigate how TGD-specific factors influence ANS balance and blood pressure regulation.

Main Methods:

  • Literature review examining the role of the ANS in CVD.
  • Analysis of how minority stress, lifestyle, sex/gender, and hormones impact ANS function in TGD individuals.
  • Synthesis of existing research on TGD populations and autonomic control.

Main Results:

  • Limited research currently exists on autonomic balance within TGD populations.
  • Potential TGD-specific factors include minority stress, lifestyle, sex/gender, and hormone levels (testosterone, estrogen, progesterone).
  • These factors may contribute to ANS imbalance, characterized by reduced parasympathetic and heightened sympathetic activity.

Conclusions:

  • Autonomic imbalance is a potential mechanism linking TGD identity to increased CVD risk.
  • Further interdisciplinary research is essential to elucidate these mechanisms.
  • Findings will advance TGD-inclusive healthcare for cardiovascular health and autonomic blood pressure control.

Keywords:
Autonomic Nervous SystemCardiovascular diseasesGender Affirming Hormone TherapyGender-diverseHeart Rate VariabilityMinority StressMuscle Sympathetic Nerve ActivityNon-binaryParasympathetic Nervous SystemSympathetic Nervous SystemTransgender

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