Prospective Short- and Long-Term Changes in Cardiometabolic Risk Markers Following Gender-Affirming Hormone Therapy

Area of Science:

• Endocrinology
• Cardiology
• Metabolic Health

Background:

• Gender-affirming hormone therapy (GAHT) is crucial for transgender individuals but may influence cardiometabolic disease (CMD) risk.
• Long-term data on CMD marker changes during GAHT are essential for comprehensive risk assessment.

Purpose of the Study:

• To prospectively evaluate changes in cardiometabolic disease risk markers over 36 months in transgender individuals undergoing GAHT.
• To differentiate effects based on gender identity (transmasculine vs. transfeminine) and GAHT status (naïve vs. ongoing).

Main Methods:

• A 36-month prospective study included transgender individuals initiating or continuing GAHT at a Danish gender identity clinic.
• Participants were categorized as transmasculine (TransM) or transfeminine (TransF).
• Annual measurements included BMI, waist-hip-ratio, lipids, blood pressure, and HbA1c.

Main Results:

• Masculinizing GAHT in TransM was linked to increased LDL, triglycerides, and decreased HDL. GAHT-naïve TransM also showed increased waist circumference and HbA1c.
• Feminizing GAHT in GAHT-naïve TransF was associated with increased weight, BMI, waist, and hip circumference, alongside decreased total cholesterol and triglycerides.
• CMD risk markers remained largely unchanged in transfeminine individuals already on GAHT.

Conclusions:

• Masculinizing GAHT is predominantly associated with long-term adverse changes in lipid profiles.
• Initiating feminizing GAHT is linked to metabolically unfavorable changes in body composition.
• These findings underscore the importance of individualized cardiometabolic risk monitoring for transgender individuals on GAHT.