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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References
- Testosterone therapy for transgender men.Lancet Diabetes Endocrinol. 2017; 5: 301-311
- Oestrogen and anti-androgen therapy for transgender women.Lancet Diabetes Endocrinol. 2017; 5: 291-300
- Privately insured transgender people are at elevated risk for chronic conditions compared with cisgender counterparts.Health Aff (Millwood). 2021; 40: 1440-1448
- Cardiovascular disease risk factors and myocardial infarction in the transgender population.Circ Cardiovasc Qual Outcomes. 2019; 12e005597
- Blood pressure effects of gender-affirming hormone therapy in transgender and gender-diverse adults.Hypertension. 2021; 77: 2066-2074
- Effects of intramuscular testosterone undecanoate on body composition and bone mineral density in female-to-male transsexuals.J Sex Med. 2010; 7: 3190-3198
- Sex steroids and cardiovascular outcomes in transgender individuals: a systematic review and meta-analysis.J Clin Endocrinol Metab. 2017; 102: 3914-3923
- Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen.J Clin Endocrinol Metab. 2019; 104: 1937-1947
- Fitting linear mixed-effects models using lme4.J Stat Softw. 2015; 67: 1-48
- Concomitant psychiatric problems and hormonal treatment induced metabolic syndrome in gender dysphoria individuals: A 2 year follow-up study.J Psychosom Res. 2015; 78: 399-406
- Body composition and bone mineral density in male-to-female transsexuals during cross-sex hormone therapy using gonadotrophin-releasing hormone agonist.Exp Clin Endocrinol Diabetes. 2011; 119: 95-100
- Clinical and biochemical effects of spironolactone administered once daily in primary hypertension. Multicenter Sweden study.Hypertension. 1980; 2: 672-679
- AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American college of cardiology/American heart association task force on clinical practice guidelines.Circulation. 2019; 139: e1082-e1143
- Prevalence of US adults with triglycerides ≥ 150 mg/dl: NHANES 2007–2014.Cardiol Ther. 2020; 9: 207-213
- Prevalence of low high-density lipoprotein cholesterol among adults, by physical activity: United States, 2011-2014.NCHS Data Brief. 2017; (Mar): 1-8
- 2021 ACC expert consensus decision pathway on the management of ASCVD risk reduction in patients with persistent hypertriglyceridemia: a report of the american college of cardiology solution set oversight committee.J Am Coll Cardiol. 2021; 78: 960-993
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.