Transgender patients who undergo hormone therapy have a significantly increased risk of serious health problems, such as stroke, heart attack, and pulmonary embolism, according to a new study.
A new study presented at an American College of Cardiology conference found that transgender patients who take cross-sex hormones had an increased risk of dangerous blood clots that can create blockages in the brain, heart, and lungs, according to a press release. The study found the subjects had nearly seven times the risk of ischemic stroke, six times the risk of the most severe type of heart attack and nearly five times the risk of pulmonary embolism, compared to those with gender dysphoria who never used hormone therapy.
“It’s all about risks and benefits,” said Dr. Ibrahim Ahmed, a third-year resident at Mercy Catholic Medical Center in Darby, Pennsylvania, and the study’s lead author. “Starting transitioning is a big part of a person’s life and helping them feel more themselves, but hormone replacement therapy also has a lot of side effects; it’s not a risk-free endeavor.”
This new study, which will be presented at the Annual Scientific Session Together With the World Congress of Cardiology in March, is the largest to date to examine the cardiovascular risks associated with hormone replacement therapy in people with gender dysphoria, a population that has not been well-researched.
The study retrospectively analyzed hospital records of more than 21,000 individuals with gender dysphoria, out of which 1,675 had undergone hormone replacement therapy. Male-to-female transgender patients often take estrogen to induce the appearance of female secondary sex characteristics, and female-to-male transgender patients frequently take testosterone to induce the appearance of male secondary sex characteristics.
Researchers said that both estrogen and testosterone are known to increase the clotting activity of blood, which could explain the increase in clotting-related cardiovascular events. Those taking hormone replacement therapy in the study also had higher rates of substance use disorder and hypothyroidism.
An ischemic stroke, for which patients in the study who had undergone hormone therapy were seven times more likely to experience, is a type of stroke that occurs when a blood clot blocks a blood vessel supplying blood to the brain, leading to a lack of blood flow and oxygen to brain tissue. This can cause damage to brain cells and result in various neurological symptoms, such as weakness or paralysis on one side of the body, speech difficulties, and vision problems.
Patients in the study who had undergone hormone treatment also had six times the increased risk of a serious type of heart attack known as ST elevation myocardial infarction (STEMI), which occurs when there is a complete blockage of one of the major arteries that supply blood to the heart muscle. The interruption of blood flow to the heart can cause significant damage to the heart muscle, and if not treated promptly, can be life-threatening.
In the study, the transgender patients who underwent hormone therapy also had five times the increased risk of a pulmonary embolism – a blockage in one of the arteries in the lungs. This can lead to serious health complications, such as damage to the lungs and other organs, and even death.
The researchers suggested that medical and family history should be considered before starting hormone replacement therapy, and individuals considering this therapy should be informed of all the potential risks. They also recommended studying the potential long-term cardiovascular and other health effects of cross-sex hormones, as the use of these therapies becomes more common. The researchers noted that the study had limitations, such as not accounting for the duration of hormone replacement therapy or the age at which it was initiated, and further research was needed to inform clinical decisions.