Sex Steroids and Cardiovascular Outcomes in Transgender Individuals: A Systematic Review and Meta-Analysis

Abstract

Low-quality evidence suggests that sex steroid therapy may increase LDL-C and TG levels and decrease HDL-C level in FTM individuals, whereas oral estrogens may increase TG levels in MTF individuals. Data about important patient outcomes remain sparse.

Testosterone undecanoate and testosterone enanthate injections are both effective and safe in transmen over 5 years of administration

“…Although some studies suggest a potential increase in the risk of thrombosis during T therapy, large retrospective and prospective studies demonstrate that in hypogonadal men, the rate of thrombosis does not increase . A recent meta‐analysis reported only one case of venous thromboembolism among 771 transmen . In our study, there was no increase in blood pressure values.…”

“…3,14,16,20 While erythrocytosis in haematologic neoplasms has been clearly linked to thrombosis, data are still lacking upon the effect of secondary erythrocytosis induced by testosterone supplementation and the increased thrombotic risk. 21 In 2017 Endocrine Society Clinical Practice Guideline, haematocrit over 50% was considered a marker of very high risk of adverse outcomes, highlighting the importance of haematocrit or haemoglobin measurements at TA B L E 6 Hormonal parameters at baseline and during follow-up of T administration in the two groups of subjects baseline and every 3 months for the first year and then once or twice a year. 2 In our study, over 5 years, no subject in either the TU or TE group had haematocrit exceeding 50%.…”

Individualized medicine: Sex, hormones, genetics, and adverse drug reactions

“…62 For trans men, (XX with testosterone treatment), general physiological and metabolic effects include increases in body mass index, modest increases in blood pressure, and increases in serum triglycerides and lowdensity lipoprotein cholesterol. 63,64 Adverse cardiovascular events include increased risk for venous thromboembolism, but this has been attributed to an oral formulation of testosterone, 61 and in some cases increased risk of myocardial infarction. 63,65 For trans women, in addition to risks for venous thromboembolism associated with oral formulations of the steroids, there is also increased risk for stroke and myocardial infarction.…”

Serum testosterone, sex hormone‐binding globulin and sex‐specific risk of incident type 2 diabetes in a retrospective primary care cohort

“…2 Androgen excess has recently been identified as an independent risk factor for non-alcoholic fatty liver disease (NAFLD) in women 3 and promotes lipid accumulation in female adipose tissue as well as systemic lipotoxicity. 5,6 Mirroring this, the adverse metabolic phenotype of male androgen deficiency bears a striking similarity to that of female androgen excess; lower testosterone levels in men are associated with impaired glucose homoeostasis, hepatic steatosis and coronary artery disease. 5,6 Mirroring this, the adverse metabolic phenotype of male androgen deficiency bears a striking similarity to that of female androgen excess; lower testosterone levels in men are associated with impaired glucose homoeostasis, hepatic steatosis and coronary artery disease.…”