The Estrogenic Burden on Vascular Risk in Male-to-Female Transsexuals

Abstract

Transsexualism refers to individuals that identify themselves as members of the opposite gender and who strive to acquire the physical appearance and psychosocial role compatible with that gender. Gender reassignment therapy is applied through hormonal treatment ± surgical intervention in addition to psychological support. Hormone treatment for male-to-female transsexuals includes estrogen supplementation ± suppression of androgen secretion or action. Sex hormones are important determinants of the metabolic profile. The impact on cardiovascular disease appears to be gender-related but overall evidence remains conflicting. Gender reassignment therapy has been associated with elevated triglyceride concentrations, often accompanied by an increase in high density lipoprotein levels, reduced circulating homocysteine (Hcy), uric acid and creatinine levels as well as an adverse effect on glycemic control. Markers of inflammation, oxidative stress and endothelial function are also affected in various ways, while alterations in hemostatic and fibrinolytic factors favor thrombosis (arterial and/or venous). Male-to-female transsexuals may be adversely affected by both estrogen administration and androgen deprivation, as reported in prostate cancer. Therefore, vascular risk factor screening and potential intervention may be required prior to and during gender reassignment therapy (both hormone and surgical).

Cardiovascular disease in transsexual persons treated with cross-sex hormones: reversal of the traditional sex difference in cardiovascular disease pattern

“…Two studies in transsexual populations indicate that MtoF treated with ethinyl estradiol, compared with other types of estrogen, are more prone to venous thrombosis (44) and to cardiovascular mortality (14). The effects of various types of estrogens and their route of administration in transsexual persons have been excellently reviewed (53).…”

Sex differences in the prevalence and clinical correlates of hyperhomocysteinemia in patients with bipolar disorder

“…The increases in Hcy levels with natural menopause and the decrease with menopausal hormone replacement therapy (Bednarek-Tupikowska et al, 2005) suggest a close relationship between Hcy metabolism and estrogen levels (Mijatovic & van der Mooren, 2001). A study of male-to-female transsexuals reported the relationship between reduced circulating Hcy and sex reassignment therapy (Lioudaki, Ganotakis, Mikhailidis, & Nair, 2010), intuitively demonstrating that the sex differences in the Hcy were associated with estrogen protection. This protection from HHcy in women with BD may be related to the estrogen effects on Hcy metabolism.…”

Gender Dysphoria – Prevalence and Co-Morbidities in an Irish Adult Population

“…It is important to identify and optimize control of these medical co-morbidities prior to initiating the hormonal phase of treatment, as they can be exacerbated by hormones such as estrogen (17–19). Close attention should be paid to the possibility of cardiovascular events, as accruing evidence has suggested that MTF GD patients may be at an increased cardiovascular risk (20–22). Twenty-six percent of patients were smokers at initial presentation which is in line with the national average of 29% (23).…”