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Gender-diverse people likely suffer from higher rates of cardiovascular disease than cisgender people. Studies on the effects of gender-affirming hormone therapy (GAHT) on blood pressure in adult transgender populations have been inconsistent. We sought to address knowledge gaps on this topic by conducting the largest and longest observational study to date using multiple blood pressure readings from a racially and ethnically diverse sample. We followed the blood pressure of 470 transgender and gender-diverse adult patients (247 transfeminine and 223 transmasculine; mean age, 27.8 years) seen at a Federally Qualified Health Center and an academic endocrinology practice, both in Washington DC. Blood pressure was measured at baseline and at multiple follow-up clinical visits up to 57 months after the initiation of GAHT. Our study found that within 2 to 4 months of starting GAHT, mean systolic blood pressure was lower in the trans feminine group by 4.0 mm Hg ( P <0.0001) and higher in the trans masculine group by 2.6 mm Hg ( P =0.02). These blood pressure changes were maintained during the whole follow-up period. There were no changes to diastolic blood pressure for either group. The prevalence of stage 2 hypertension decreased in the trans feminine group by 47% ( P =0.001) within 2 to 4 months of GAHT. In conclusion, our data support routine blood pressure monitoring after the initiation of GAHT. Further research is needed on the effects of GAHT in older gender-diverse individuals and on optimal formulations of GAHT.

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