The Effect of Gender-Affirming Hormone Therapy on the Risk of Subclinical Atherosclerosis in the Transgender Population: A Systematic Review

被引：18
作者：
Allgayer, Roberta M. C. Moreira [1 ,2 ,3 ]
Borba, Gustavo da Silva [1 ,2 ]
Moraes, Ruy Silveira [4 ]
Ramos, Ramon Bossardi [3 ,5 ]
Spritzer, Poli Mara [1 ,2 ,3 ,6 ,7 ]
机构：
[1] Hosp Clin Porto Alegre, Div Endocrinol, Gynecol Endocrinol Unit, Porto Alegre, Brazil
[2] Hosp Clin Porto Alegre, Gender Ident Program, Porto Alegre, Brazil
[3] Univ Fed Rio Grande De Sul, Med Sch, Postgrad Program Endocrinol, Porto Alegre, Brazil
[4] Hosp Clin Porto Alegre, Div Cardiol, Porto Alegre, Brazil
[5] Albany Med Coll, Dept Mol & Cellular Physiol, Albany, NY USA
[6] Univ Fed Rio Grande Do Sul, Dept Physiol, Porto Alegre, Brazil
[7] Hosp Clin Porto Alegre, Div Endocrinol, Rua Ramiro Barcelos 2350, BR-90035003 Porto Alegre, RS, Brazil
来源：
ENDOCRINE PRACTICE | 2023年 / 29卷 / 06期
关键词：
transgender people; gonadal steroids; testosterone; estrogens; cardiovascular risk; atherosclerosis; DEPOT MEDROXYPROGESTERONE ACETATE; IMPROVES VASCULAR FUNCTION; INTIMA MEDIA THICKNESS; ENDOTHELIAL FUNCTION; CARDIOVASCULAR-DISEASE; ARTERIAL STIFFNESS; REPLACEMENT THERAPY; ESTROGEN THERAPY; SEX STEROIDS; NITRIC-OXIDE;
D O I：
10.1016/j.eprac.2022.12.017
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Objective: The impact of gender-affirming hormone therapy (GAHT) on cardiovascular (CV) health is still not entirely established. A systematic review was conducted to summarize the evidence on the risk of subclinical atherosclerosis in transgender people receiving GAHT.Methods: A systematic review was performed following Preferred Reporting Items for Systematic Re-views and Meta-analyses guidelines, and data were searched in PubMed, LILACS, EMBASE, and Scopus databases for cohort, case-control, and cross-sectional studies or randomized clinical trials, including transgender people receiving GAHT. Transgender men and women before and during/after GAHT for at least 2 months, compared with cisgender men and women or hormonally untreated transgender per-sons. Studies reporting changes in variables related to endothelial function, arterial stiffness, autonomic function, and blood markers of inflammation/coagulation associated with CV risk were included. Results: From 159 potentially eligible studies initially identified, 12 were included in the systematic review (8 cross-sectional and 4 cohort studies). Studies of trans men receiving GAHT reported increased carotid thickness, brachial-ankle pulse wave velocity, and decreased vasodilation. Studies of trans women receiving GAHT reported decreased interleukin 6, plasminogen activator inhibitor-1, and tissue plasminogen activator levels and brachial-ankle pulse wave velocity, with variations in flow-mediated dilation and arterial stiffness depending on the type of treatment and route of administration.Conclusions: The results suggest that GAHT is associated with an increased risk of subclinical athero-sclerosis in transgender men but may have either neutral or beneficial effects in transgender women. The evidence produced is not entirely conclusive, suggesting that additional studies are warranted in the context of primary prevention of CV disease in the transgender population receiving GAHT. Systematic Review Registration: PROSPERO, identifier CRD42022323757.& COPY; 2023 AACE. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码：498 / 507
页数：10
相关论文
共 60 条
[11]   Effects of short-term transdermal estradiol administration on plasma levels of nitric oxide in postmenopausal women [J].
Cicinelli, E ;
Ignarro, LJ ;
Schönauer, LM ;
Matteo, MG ;
Galantino, P ;
Balzano, G .
FERTILITY AND STERILITY, 1998, 69 (01) :58-61
[12]   New markers for cardiovascular disease risk in women: Impact of endogenous estrogen status and exogenous postmenopausal hormone therapy [J].
Davison, S ;
Davis, SR .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2003, 88 (06) :2470-2478
[13]   Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria [J].
de Blok, Christel J. M. ;
Wiepjes, Chantal M. ;
van Velzen, Daan M. ;
Staphorsius, Annemieke S. ;
Nota, Nienke M. ;
Gooren, Louis J. G. ;
Kreukels, Baudewijntje P. C. ;
den Heijer, Martin .
LANCET DIABETES & ENDOCRINOLOGY, 2021, 9 (10) :663-670
[14]   Increased arterial stiffness in female-to-male transsexuals treated with androgen [J].
Emi, Yayoi ;
Adachi, Miwa ;
Sasaki, Aiko ;
Nakamura, Yoshio ;
Nakatsuka, Mikiya .
JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH, 2008, 34 (05) :890-897
[15]   Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons A Cohort Study [J].
Getahun, Darios ;
Nash, Rebecca ;
Flanders, W. Dana ;
Baird, Tisha C. ;
Becerra-Culqui, Tracy A. ;
Cromwell, Lee ;
Hunkeler, Enid ;
Lash, Timothy L. ;
Millman, Andrea ;
Quinn, Virginia P. ;
Robinson, Brandi ;
Roblin, Douglas ;
Silverberg, Michael J. ;
Safer, Joshua ;
Slovis, Jennifer ;
Tangpricha, Vin ;
Goodman, Michael .
ANNALS OF INTERNAL MEDICINE, 2018, 169 (04) :205-+
[16]   Oral, but not transdermal, administration of estrogens lowers tissue-type plasminogen activator levels in humans without affecting endothelial synthesis [J].
Giltay, EJ ;
Gooren, LJG ;
Emeis, JJ ;
Kooistra, T ;
Stehouwer, CDA .
ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 2000, 20 (05) :1396-1403
[17]   Sex steroids, insulin, and arterial stiffness in women and men [J].
Giltay, EJ ;
Lambert, J ;
Gooren, LJG ;
Elbers, JMH ;
Steyn, M ;
Stehouwer, CDA .
HYPERTENSION, 1999, 34 (04) :590-597
[18]   2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [J].
Goff, David C., Jr. ;
Lloyd-Jones, Donald M. ;
Bennett, Glen ;
Coady, Sean ;
D'Agostino, Ralph B. ;
Gibbons, Raymond ;
Greenland, Philip ;
Lackland, Daniel T. ;
Levy, Daniel ;
O'Donnell, Christopher J. ;
Robinson, Jennifer G. ;
Schwartz, J. Sanford ;
Shero, Susan T. ;
Smith, Sidney C., Jr. ;
Sorlie, Paul ;
Stone, Neil J. ;
Wilson, Peter W. F. .
CIRCULATION, 2014, 129 (25) :S49-S73
[19]   Cardiovascular disease in transsexual persons treated with cross-sex hormones: reversal of the traditional sex difference in cardiovascular disease pattern [J].
Gooren, Louis J. ;
Wierckx, Katrien ;
Giltay, Erik J. .
EUROPEAN JOURNAL OF ENDOCRINOLOGY, 2014, 170 (06) :809-819
[20]   Compromised endothelial function in transgender men taking testosterone [J].
Gulanski, Barbara I. ;
Flannery, Clare A. ;
Peter, Patricia R. ;
Leone, Cheryl A. ;
Stachenfeld, Nina S. .
CLINICAL ENDOCRINOLOGY, 2020, 92 (02) :138-144
123456