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. 2022 Mar 15;17(3):e0261312.
doi: 10.1371/journal.pone.0261312. eCollection 2022.

The effect of transdermal gender-affirming hormone therapy on markers of inflammation and hemostasis

Moya H Schutte  1 , Robert Kleemann  2   3 , Nienke M Nota  1 , Chantal M Wiepjes  1 , Jessica M Snabel  2 , Guy T'Sjoen  4 , Abel Thijs  5 , Martin den Heijer  1
Affiliations

The effect of transdermal gender-affirming hormone therapy on markers of inflammation and hemostasis

Moya H Schutte et al. PLoS One. .

Abstract

Background: Cardiovascular risk is increased in transgender persons using gender-affirming hormone therapy. To gain insight into the mechanism by which sex hormones affect cardiovascular risk in transgender persons, we investigated the effect of hormone therapy on markers of inflammation and hemostasis.

Methods: In this exploratory study, 48 trans women using estradiol patches plus cyproterone acetate (CPA) and 47 trans men using testosterone gel were included. They were between 18 and 50 years old and did not have a history of cardiovascular events. Measurements were performed before and after 3 and 12 months of hormone therapy.

Results: After 12 months, in trans women, systemic and endothelial inflammatory markers decreased (hs-CRP -66%, (95% CI -76; -53), VCAM-1-12%, (95% CI -16; -8)), while platelet activation markers increased (PF-4 +17%, (95% CI 4; 32), β-thromboglobulin +13%, (95% CI 2; 24)). The coagulation marker fibrinogen increased transiently, after 3 months (+15%, (95% CI 1; 32)). In trans men, hs-CRP increased (+71%, (95% CI 19; 145)); platelet activation and coagulation markers were not altered. In both trans women and trans men, leptin and adiponectin changed towards reference values of the experienced gender.

Conclusions: Platelet activation and coagulation marker concentrations increased in trans women using transdermal estradiol plus CPA, but not in trans men using testosterone. Also, concentrations of inflammatory markers decreased in trans women, while hs-CRP increased in trans men. Our results indicate that hormone therapy may affect hemostasis in transgender persons, which could be an underlying mechanism explaining the increased cardiovascular risk in this population.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flowchart.
Fig 2
Fig 2. %-change after 3 and 12 months of hormone therapy in trans women and trans men.
Values are presented as geometric mean with 95% confidence interval. Measures were log-transformed for analysis and back-transformed for presentation. Scales are logarithmic. For hs-CRP and leptin, a larger scale is used.
See this image and copyright information in PMC

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