Impact of Long-Term Gender-Affirming Hormone Therapy on Cardiac Function in Transgender Youth
Overview
This cross-sectional study evaluated cardiac function and aortic elasticity in transgender men and women who initiated gender-affirming hormone therapy (GAHT) during adolescence and continued treatment for 5–10 years. Findings showed normal cardiac systolic and diastolic function and chamber dimensions, but revealed reduced aortic distensibility and increased stiffness, suggesting early vascular changes.
Background
Transgender and gender diverse individuals often pursue gender-affirming hormone therapy to align physical characteristics with their gender identity, frequently starting during adolescence. While GAHT can induce metabolic changes that may influence cardiovascular risk, the long-term cardiac effects of hormone therapy initiated during puberty remain unclear. Understanding these effects is critical given the cardiovascular sexual dimorphism emerging during adolescence and the increasing number of youth undergoing GAHT.
Data Highlights
Parameter
Trans Men (TM)
Trans Women (TW)
Median GAHT Duration (years)
6.0 (IQR 2.8)
7.8 (IQR 2.6)
Median Age (years)
23.4 (IQR 2.2)
25.3 (IQR 2.7)
Systolic Function
Normal in all
Normal in all
Diastolic Dysfunction
1 case grade 2 dysfunction
None reported
LV Diameters and Mass
Within normal range
Within normal range
Aortic Diameters
Within normal range
Within normal range
Aortic Distensibility
Significantly reduced vs. normal
Significantly reduced vs. normal
Aortic Stiffness Index
Increased
Increased
Key Findings
All participants exhibited normal systolic cardiac function; only one trans man showed grade 2 diastolic dysfunction.
Left ventricular dimensions and mass indexed for body surface area were within normal reference ranges for both trans men and women.
Aortic diameters remained within normal limits despite long-term GAHT.
Both trans men and women demonstrated significantly reduced aortic distensibility and strain compared to normal values, indicating increased aortic stiffness.
In trans men, reduced aortic distensibility correlated independently with higher systolic blood pressure.
Clinical Implications
Long-term GAHT initiated during adolescence appears safe with respect to cardiac systolic and diastolic function and ventricular structure. However, observed alterations in aortic elasticity suggest early vascular changes that warrant monitoring. Clinicians should consider regular cardiovascular assessments, including blood pressure management, to mitigate potential long-term vascular risks in transgender youth receiving GAHT.
Conclusion
GAHT started in adolescence does not adversely affect cardiac function or chamber size in young transgender adults but is associated with changes in aortic elasticity. Further longitudinal studies are needed to determine the clinical significance of these vascular alterations.
References
Ghent University Hospital Ethics Committee 2023–2024 -- Impact of Gender-Affirming Hormone Treatment from Teen Years to Adulthood on Heart Function
