Clinical Scorecard: Evaluating Cardiometabolic Risk in Transgender Populations: The Impact of Sex Hormones and Chromosomal Differences

At a Glance

Key Highlights

• Transgender men develop a proatherogenic lipoprotein profile and increased diabetes risk markers after hormone therapy.
• Transgender women show early beneficial changes in cardiometabolic biomarkers with estrogen treatment.
• Sex chromosomes have fewer intrinsic effects on cardiometabolic risk compared to sex hormones.

Guideline-Based Recommendations

Diagnosis

• Assess cardiometabolic risk biomarkers including lipoproteins, metabolites, and vascular function in transgender patients.
• Consider sex hormone status and chromosomal sex when interpreting cardiometabolic risk profiles.

Management

• Monitor changes in lipid profiles and glucose metabolism during gender-affirming hormone therapy.
• Tailor cardiovascular risk management strategies to the specific effects of hormone therapy in transgender men and women.

Monitoring & Follow-up

• Regularly evaluate blood pressure, lipid panels, glucose levels, and vascular function at baseline and during hormone therapy.
• Monitor cholesterol efflux capacity as a marker of HDL function, especially in transgender women.

Risks

• Increased systolic blood pressure and proatherogenic lipid changes in transgender men.
• Potential decrease in cholesterol efflux capacity in transgender women.
• Elevated apparent diabetes risk in XY individuals and transgender men.

Patient & Prescribing Data

Transgender men and women undergoing gender-affirming hormone therapy

Hormonal castration followed by cross-sex hormone therapy alters cardiometabolic biomarkers differently in transgender men and women, necessitating individualized risk assessment.

Clinical Best Practices

• Incorporate comprehensive cardiometabolic biomarker panels including nuclear magnetic resonance spectroscopy for detailed lipoprotein analysis.
• Avoid use of ethinyl estradiol in transgender women due to adverse cardiometabolic effects.
• Recognize the need for validated cardiometabolic risk prediction tools specific to transgender populations.
• Provide tailored counseling and monitoring to address increased cardiovascular and diabetes risk in transgender men.

References

• GEnder Dysphoria Treatment in Sweden study (GETS), Clinical Trials identifier NCT02518009