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Originally published by 2 Minute Medicine® (view original article). Reused on AccessPediatrics with permission.

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1. Cross-sex hormone therapy (CSHT) may be associated with worsening cardiovascular risk factors in transgender men.

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2. CSHT may not result in increases in cardiovascular morbidity or mortality.

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Evidence Rating Level: 2 (Good)

Study Rundown:

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Understanding the unique health care needs of the transgender population is highly important; approximately 1.4 million persons identify as transgender in the United States. One important area of study involves the role of sex hormones—including hormone blockers and cross-sex hormone therapy—and cardiovascular disease (CVD). Sex hormones may be used to help transgender persons fully realize their gender identity. Despite the importance of this area of research, one of the barriers to providing appropriate care to transgender persons is the lack of physician training and clinical guidelines within this area. Additionally, there is limited health care research within this population. The authors of this study, therefore, conducted a systematic review that highlights research on the association between hormone therapy and CVD in cisgender adults, in addition to summarizing the association between CSHT and CVD in transgender adults. This study has several limitations. First, many studies included in this review focus on younger persons, limiting the generalizability of CSHT in older transgender adults. Additionally, there are few randomized controlled trials with respect to CSHT, which limits knowledge of any associations between CSHT and CVD.

In-Depth [narrative review]:

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The authors of this study systematically searched PubMed and EMBASE databases, of which 13 met inclusion and exclusion criteria. Of the articles, 3 reported findings only in transgender women, 3 only in transgender men, and 7 looked at both populations. Based on the articles reviewed, the authors observed that CSHT is associated with improved psychological functioning of transgender persons. While studies looking at CSHT and cardiovascular risk factors in transgender men are limited, several studies, including an early prospective study and an observational longitudinal study, suggest that CSHT increases CVD risk factors. These risk factors include blood pressure values, lipid levels, and insulin resistance. Furthermore, in transgender women, CSHT may increase thromboembolic risk. However, due to the lack of randomized controlled trials and prospective cohort studies found in this review, it is clear that further research is required to determine the cardiovascular effects of long-term CSHT for transgender adults.

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