New research on gender-affirming therapy for young transgender people suggests that gender-affirming hormone therapy didn't have any particular adverse effects when it comes to cardiovascular disease. In fact, it might be beneficial (but more work is needed).
The findings are announced at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference 2021. 50 trans girls and 50 trans boys aged between 12 and 21 were randomly picked from 300 patients who got gender-affirming hormone therapy at the Adolescent Medicine Clinic at Primary Children’s Hospital in Salt Lake City.
This cohort had a naturally higher atherosclerotic cardiovascular disease (ASCVD) risk factor compared to a cohort of similarly aged cisgender individuals (whose gender is the same as that assigned at birth). Before the hormonal therapy, 50 percent of the transgender girls and 66 percent of the transgender guys had at least one ASCVD risk factor compared to 37 percent of cisgender adolescents, estimated based on previous research.
After a year of hormone therapy, the changes were intriguing. The number of young trans women with an ASCVD risk factor was just 30 percent, with the type of risk factor remaining unchanged. The number of trans men with ASCVD risk factors increased slightly to 70 percent, and these young men had a significant decrease in HDL cholesterol.
“Gender-affirming hormone therapy appears to have greater benefits than risks for transgender adolescents and young adults,” the work’s principal investigator Dr Nicole L. Mihalopoulos, chief of the division of adolescent medicine at the University of Utah, said in a statement. “For some people, these findings influence their decision to not to start gender-affirming hormones during adolescence. However, without gender-affirming hormone therapy, transgender individuals may experience worse gender dysphoria, depression, anxiety and possibly increased suicidal ideations.”
The study is limited in the number of individuals, their backgrounds, and the length since it did only a one-year follow-up. The team is upfront that these results are preliminary, but they stress that the study brings more insight into cardiovascular disease in transgender people. While previous research suggests a possible link between hormones and higher blood pressure, research has not been able to find a statistical connection.
It is important also to stress that not every transgender person chooses to undergo gender-affirming medical interventions, and it is important that options are presented scientifically without scaremongering. The hormones in question, estrogen and testosterone, are naturally present in every human.
“Gender-affirming hormone therapy is an option for transgender individuals, and yet very little research currently focuses on the transgender adolescent community,” explained first author Ambur Staab, from the University of Utah School of Medicine in Salt Lake City. “Heart disease is the leading cause of mortality in the United States, and we understand, to some degree from previous research, that estrogen and testosterone can impact risk factors for heart disease. We have yet to fully study how these hormones affect heart disease risk specifically in the transgender adolescent/young adult population, and we sought to get a better understanding through this study.”
Thanks to relative higher social acceptance, role models, and parental support more people can now come out as transgender – especially younger individuals. These young people are also facing stigma, hostile media and public figures, as well as proposed laws just for wanting to be who they are.