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. 2024 Apr 30:36:100349.
doi: 10.1016/j.jcte.2024.100349. eCollection 2024 Jun.

Changes in Blood Lipids Following Initiation of Gender Affirming Hormone Therapy: A Systematic Review and Meta-Analysis

Bennett Gosiker  1 , Jude Moutchia  2 , Nghiem Nguyen  1 , Darios Getahun  3   4 , Michael Goodman  5
Affiliations

Changes in Blood Lipids Following Initiation of Gender Affirming Hormone Therapy: A Systematic Review and Meta-Analysis

Bennett Gosiker et al. J Clin Transl Endocrinol. .

Abstract

Aim: The aim of this study was to conduct a systematic review and meta-analysis of changes in low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol, and triglycerides following initiation of feminizing or masculinizing gender affirming hormone therapy (GAHT).

Methods: A search of Ovid MEDLINE, Embase, Web of Science, SCOPUS, and CINAHL databases identified potentially relevant articles published from 1990 through 2024. Both observational and randomized trials of adults receiving feminizing or masculinizing GAHT with baseline and follow-up measures were included. Articles were reviewed for eligibility using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. The risk of bias in each study was quantified using the NHLBI Study Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group. Random effects models were used to compute the before-and-after meta-differences in mean values for each parameter along with the I2 statistic to assess heterogeneity of results.

Results: Thirty-five studies met the criteria for inclusion in the meta-analysis. Masculinizing GAHT was associated with significant changes in serum lipids from baseline up through the 60-month timepoint with meta-difference of means (95% CI) estimates of 26.2mg/dL (23.3,29.0) for LDL-C, 26.1mg/dL (22.8,29.4) for total cholesterol, 30.7mg/dL (6.9,54.6) for triglycerides and -9.4mg/dL (-12.1, -6.7) for HDL-C. Studies evaluating the effects of feminizing GAHT on balance demonstrated no notable changes in HDL-C or triglycerides while the results for LDL-C and total cholesterol were inconsistent. Heterogeneity of results ranged from minimal (I2 = 0%) to substantial (I2 = 90%).

Conclusions: While the results for transfeminine individuals on GAHT appear somewhat reassuring, transmasculine patients receiving testosterone may benefit from closer monitoring of lipid profiles.

Keywords: Gender Affirming Hormone Therapy; Lipids; Transgender and Gender Diverse.

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Conflict of interest statement

Dr. Goodman’s and Dr. Getahun’s past and current research support includes Contract AD-12-11-4532 from the Patient Centered Outcome Research Institute, Grant R21HD076387 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Grant R01AG066956 from the National Institute of Aging. Dr. Goodman provides consulting services through Epidemiologic Research & Methods, LLC; his consulting services are not related to the topic of this publication. Other authors do not have any funding or competing interests to declare.The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michael Goodman, Darios Getahun reports a relationship with Patient-Centered Outcomes Research Institute that includes: funding grants. Michael Goodman, Darios Getahun reports a relationship with National Institute of Child Health and Human Development that includes: funding grants. Michael Goodman, Darios Getahun reports a relationship with National Institute of Aging that includes: funding grants. Michael Goodman reports a relationship with Epidemiologic Research & Methods, LLC that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.].

Figures

Fig. 1
Fig. 1
PRISMA flowchart of the study selection process.
Fig. 2
Fig. 2
Longitudinal absolute changes in lipid values from baseline. Longitudinal absolute changes in lipid values from baseline for transmasculine (left panel) and transfeminine (right panel) patients. Shaded region of each graph reflects meta-regression results with the change in value on a monthly basis displayed at the top of each graph.
See this image and copyright information in PMC

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