Cardiovascular Health Issues in Transgender Persons

In the last 10 years increasing numbers of trans- and gender diverse individuals (TGDs) seek treatment to align their body to their gender identity. Treatment may consist, among others, of mental health support, hormonal treatment and surgical intervention. Gender-affirming hormone treatment (GAHT) aims to develop characteristics of the identified gender and thereby diminishing feelings of gender dysphoria. GAHT with testosterone/estrogens should be provided only after careful counseling about the advantages and disadvantages. GAHT in TGDs is generally considered to be safe and well tolerated. However, there is evidence that sex hormones influence several cardiovascular (CV) risk factors such as BMI, lipide profile, and blood pressure. Also, the risk for venous thromboembolic events is influenced. Therefore, GAHT for TGDs requires a multidisciplinary approach in which CV risk assessment is part of the counseling prior to treatment initiation (besides the evaluation of fertility). The contribution of (life style) factors (comorbidities, estrogen types, smoking, alcohol abuse) is addressed to balance the advantages against the disadvantages of treatment together. During GAHT, TGDs have to be carefully monitored lifelong for adverse effects in this area. In this chapter we describe the CV risk factors and CV disease in TGDs who are treated with feminizing and in TGDs treated with masculinizing GAHT.