Highlights
- •Testosterone in transmasculine individuals increases triglycerides by 26–37%.
- •Low HDL-cholesterol is relatively common among gender-diverse individuals.
- •Hormone therapy alters HDL-cholesterol in gender-diverse individuals.
Abstract
Background
The effects of gender-affirming hormone therapy on lipid profiles among transgender
adults have been inconsistent and incompletely characterized.
Objective
To longitudinally assess changes to lipid profiles following hormone therapy and to
establish prevalence rates of hyperlipidemia/low HDL-cholesterol.
Methods
This longitudinal study followed lipid profiles of 366 transgender and gender-diverse
adult patients (170 transfeminine and 196 transmasculine; mean age, 28 years) in Washington
DC USA. Lipid profiles were measured at baseline and at multiple follow-up clinical
visits up to 57 months after the initiation of hormone therapy.
Results
Within 2–10 months of starting gender-affirming hormone therapy, mean levels of HDL-cholesterol
decreased by 16% in transmasculine individuals and increased by 11% in transfeminine
individuals. Over the study, mean triglyceride levels increased by 26–37% in the transmasculine
group. Over the study, the prevalence of moderate hypertriglyceridemia (175–499 mg/dL)
ranged from 11 to 32% in the transfeminine group and 6–19% in the transmasculine group.
Severe hypertriglyceridemia (≥500 mg/dL) was only observed in one individual. On hormone
therapy, 24–30% of the transfeminine group had a HDL-cholesterol < 50 mg/dL and 16–24%
of the transmasculine group had a HDL-cholesterol < 40 mg/dL. LDL-cholesterol levels
≥160 mg/dL were rare among both groups.
Conclusions
In a gender-diverse population on hormone therapy, low HDL-cholesterol and moderate
hypertriglyceridemia were relatively common. HDL-cholesterol decreased with testosterone
therapy and increased with a combination of oral estrogen and spironolactone. Testosterone
use was associated with an increase in triglycerides. Our data support the recommendation
to routinely monitor lipid profiles in gender-diverse patients on GAHT.
Keywords
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Article info
Publication history
Published online: November 21, 2022
Accepted:
November 16,
2022
Received:
July 22,
2022
Identification
Copyright
© 2022 National Lipid Association. Published by Elsevier Inc. All rights reserved.
