Aims
This study aimed to investigate the association of testosterone replacement therapy (TTh) with risk of cardiovascular disease (CVD), and CVD-specific outcomes, in cisgender women and transgender population, and to determine whether this association varies by menopausal status.
Methods
In 25,796 cisgender women and 1,580 transgender people (≥ 30 yrs old), who were enrolled in the Optum’s de-identified Clinformatics® Data Mart Database (2007-2021), we identified 6288 pre- and post-menopausal cisgender women and 262 transgender people diagnosed with incident composite of CVD (coronary artery disease [CAD], congestive heart failure [CHF], stroke, myocardial infarction). Pre-diagnostic prescription of TTh was ascertained for this analysis. Multivariable adjusted Cox proportional hazards models were used to examine the independent association of TTh with incident CVD.
Results
We found a 24% increased risk of CVD (HR = 1.24, 95% CI: 1.15, 1.34), 26% risk of CAD (HR = 1.26, 95% CI: 1.14, 1.39) and a 29% risk of stroke (HR = 1.29, 95% CI: 1.14, 1.45) after comparing cisgender women who used TTh with non-users. Stratification by age group showed similar effects of TTh on CVD, CAD and stroke. Among transgender people, TTh did not increase the risk of composite CVD, including by age stratification.
Conclusion
Use of TTh increased the risk of CVD, CAD and stroke among is cisgender women, but not among transgender people. TTh is becoming more widely accepted in women, and it is the main medical treatment for transgender males. Therefore, use of TTh should be further investigated for the prevention of CVD.