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. 2024 Sep 9;3(10):101265.
doi: 10.1016/j.jacadv.2024.101265. eCollection 2024 Oct.

Impact of Gender-Affirming Hormonal Therapy on Cardiovascular Risk Factors in Transgender Health: An Updated Meta-Analysis

Saad Ur Rahman  1 , Nouraldeen Manasrah  2 , Nomesh Kumar  3 , Mohammad Hamza  4 , Aakanksha Sharma  5 , Neel Patel  6 , Bansari Patel  7 , Masooma Naseem  8 , Saman Razzaq  9 , Seemab Imtiaz Gill  10 , Hamza Naveed  11 , Khaled M Harmouch  3 , Yasemin Bahar  12 , Muhammad Aamir  13 , Yasar Sattar  14 , M Chadi Alraies  15
Affiliations

Impact of Gender-Affirming Hormonal Therapy on Cardiovascular Risk Factors in Transgender Health: An Updated Meta-Analysis

Saad Ur Rahman et al. JACC Adv. .

Abstract

Background: Gender-affirming hormone therapy (GAHT) is common among transgender individuals, but its impact on lipid profile and cardiovascular health is not well studied.

Objectives: The authors performed a systematic review and meta-analysis of existing literature to assess the impact of GAHT on lipid profiles and metabolic cardiovascular risk factors in transgender individuals.

Methods: Online databases including MEDLINE/PubMed, Embase, and Cochrane Central registry were searched to find studies on lipid profile changes in women who are transgender, also referred to as transfeminine (TF), and men who are transgender, also referred to as transmasculine (TM) before and after GAHT. Baseline comorbidities were analyzed using descriptive statistics, and R-statistical software was used to analyze the mean difference in lipid profile change between the two cohorts (pre- and post-GAHT therapy) including transgender patients.

Results: Overall, 1,241 TM and 992 TF patients were included from 12 observational studies and 12 randomized controlled trials. The mean age among TM and TF was 28 years and 30 years, respectively. The mean follow-up duration (including pre- and post-GAHT therapy) was 28 months in TM patients and 39 months in TF patients. When compared to baseline measures, TM patients had a significant increase in low-density lipoprotein, triglyceride levels, and total cholesterol while high-density lipoprotein levels decreased. In TF patients, there was a significant increase in triglyceride levels.

Conclusions: GAHT affects lipid profiles in transgender patients; however, additional studies are needed to determine how these changes impact clinical outcomes.

Keywords: dyslipidemia; gender-affirming hormonal therapy GAHT; hyperlipidemia; lipid profile; trans feminine TF; trans masculine TM.

PubMed Disclaimer

Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Impact of Gender-Affirming Hormonal Therapy on Cardiovascular Risk Factors in Transgender Health: An Updated Meta-Analysis The outcomes of lipid profile comparison of pre- and post-GAHT use among transmasculine (TM) and transfeminine (TF) populations. Abbreviations as in Figure 2.
Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow of the Search Strategy for Systematic Review and Meta-Analysis
Figure 2
Figure 2
Forest Plots for Primary Outcomes Comparing Lipid Profile Pre- and Post-GAHT Use Among Transmasculine (TM) Individuals (A) Change in LDL levels pre-GAHT (baseline) and post-GAHT use. (B) Change in HDL levels pre-GAHT (baseline) and post-GAHT use. (C) Change in TG levels pre-GAHT (baseline) and post-GAHT use. (D) Change in TC levels pre-GAHT (baseline) and post-GAHT use. GAHT = gender-affirming hormone therapy; HDL = high-density lipoprotein; LDL = low-density lipoprotein; SMD = standard mean difference; TC = total cholesterol; TG = triglyceride.
Figure 2
Figure 2
Forest Plots for Primary Outcomes Comparing Lipid Profile Pre- and Post-GAHT Use Among Transmasculine (TM) Individuals (A) Change in LDL levels pre-GAHT (baseline) and post-GAHT use. (B) Change in HDL levels pre-GAHT (baseline) and post-GAHT use. (C) Change in TG levels pre-GAHT (baseline) and post-GAHT use. (D) Change in TC levels pre-GAHT (baseline) and post-GAHT use. GAHT = gender-affirming hormone therapy; HDL = high-density lipoprotein; LDL = low-density lipoprotein; SMD = standard mean difference; TC = total cholesterol; TG = triglyceride.
Figure 3
Figure 3
Forest Plots for Primary Outcomes Comparing Lipid Profile Pre- and Post-GAHT Use Among Transfeminine (TF) Individuals (A) Change in LDL levels pre-GAHT (baseline) and post-GAHT use. (B) Change in HDL levels pre-GAHT (baseline) and post-GAHT use. (C) Change in TG levels pre-GAHT (baseline) and post-GAHT use. (D) Change in TC levels pre-GAHT (baseline) and post-GAHT use. Abbreviations as in Figure 2.
Figure 3
Figure 3
Forest Plots for Primary Outcomes Comparing Lipid Profile Pre- and Post-GAHT Use Among Transfeminine (TF) Individuals (A) Change in LDL levels pre-GAHT (baseline) and post-GAHT use. (B) Change in HDL levels pre-GAHT (baseline) and post-GAHT use. (C) Change in TG levels pre-GAHT (baseline) and post-GAHT use. (D) Change in TC levels pre-GAHT (baseline) and post-GAHT use. Abbreviations as in Figure 2.
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