Clinical Scorecard: Assessing Cardiovascular Risk Accurately in Individuals Seeking Gender-Affirming Care
At a Glance
Category
Detail
Condition
Cardiovascular risk assessment in transgender and gender-diverse (TGD) individuals undergoing gender-affirming hormone therapy (GAHT)
Key Mechanisms
GAHT influences cardiovascular risk via hormonal effects on coagulation, lipid profiles, blood viscosity, and endothelial function; baseline psychosocial and lifestyle factors also impact risk
Target Population
Transgender and gender-diverse individuals seeking gender-affirming care including hormone therapy
Care Setting
Preventive cardiology and gender-affirming clinical care settings
Key Highlights
GAHT with oestrogen in TGD women may increase thrombo-embolic risk despite favorable lipid changes.
Testosterone therapy in TGD men may worsen cardiovascular risk factors such as lipid profile and hematocrit.
Current cardiovascular risk assessment tools inadequately address the dynamic risk changes during gender transition.
Guideline-Based Recommendations
Diagnosis
Recognize limitations of binary sex-based cardiovascular risk tools when applied to TGD individuals.
Consider baseline cardiovascular risk factors including psychosocial stress and physical inactivity prior to GAHT.
Management
Monitor cardiovascular risk factors closely during GAHT, adjusting clinical approach based on evolving risk profiles.
Incorporate individualized assessment of hormone type, dose, and duration in risk management.
Monitoring & Follow-up
Regularly evaluate lipid profiles, hematocrit, blood pressure, and thrombo-embolic risk markers during GAHT.
Assess changes in physical activity and psychosocial stressors impacting cardiovascular health.
Risks
Increased thrombo-embolic events risk with oestrogen therapy in TGD women.
Potential polycythaemia and atherogenic lipid changes with testosterone therapy in TGD men.
Underestimation or misclassification of cardiovascular risk using traditional models in TGD populations.
Patient & Prescribing Data
Transgender and gender-diverse individuals undergoing feminizing or masculinizing hormone therapy
Oestrogen therapy may reduce LDL and increase HDL but raises thrombotic risk; testosterone therapy may increase hematocrit and worsen lipid profile, aligning risk closer to cisgender men.
Clinical Best Practices
Use a comprehensive, individualized cardiovascular risk assessment approach beyond binary sex classification.
Incorporate psychosocial and lifestyle factors influencing baseline cardiovascular risk in TGD patients.
Advocate for development and use of tailored cardiovascular risk models specific to TGD populations.
Monitor cardiovascular parameters longitudinally throughout gender-affirming treatment.
Educate patients on modifiable cardiovascular risk factors and promote physical activity and social support.
