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Lipid profiles and hypertriglyceridemia among transgender and gender diverse adults on gender-affirming hormone therapy

Published:November 21, 2022DOI:https://doi.org/10.1016/j.jacl.2022.11.010

      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

        • Irwig M.S.
        Testosterone therapy for transgender men.
        Lancet Diabetes Endocrinol. 2017; 5: 301-311
        • Tangpricha V.
        • den Heijer M.
        Oestrogen and anti-androgen therapy for transgender women.
        Lancet Diabetes Endocrinol. 2017; 5: 291-300
        • Hughes L.
        • Shireman T.I.
        • Hughto J.
        Privately insured transgender people are at elevated risk for chronic conditions compared with cisgender counterparts.
        Health Aff (Millwood). 2021; 40: 1440-1448
        • Alzahrani T.
        • Nguyen T.
        • Ryan A.
        • et al.
        Cardiovascular disease risk factors and myocardial infarction in the transgender population.
        Circ Cardiovasc Qual Outcomes. 2019; 12e005597
        • Banks K.
        • Kyinn M.
        • Leemaqz S.Y.
        • Sarkodie E.
        • Goldstein D.
        • Irwig MS.
        Blood pressure effects of gender-affirming hormone therapy in transgender and gender-diverse adults.
        Hypertension. 2021; 77: 2066-2074
        • Mueller A.
        • Haeberle L.
        • Zollver H.
        • et al.
        Effects of intramuscular testosterone undecanoate on body composition and bone mineral density in female-to-male transsexuals.
        J Sex Med. 2010; 7: 3190-3198
        • Maraka S.
        • Singh Ospina N.
        • Rodriguez-Gutierrez R.
        • et al.
        Sex steroids and cardiovascular outcomes in transgender individuals: a systematic review and meta-analysis.
        J Clin Endocrinol Metab. 2017; 102: 3914-3923
        • van Velzen D.M.
        • Paldino A.
        • Klaver M.
        • et al.
        Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen.
        J Clin Endocrinol Metab. 2019; 104: 1937-1947
        • Bates D.
        • Machler M.
        • Bolker B.
        • Walker S.
        Fitting linear mixed-effects models using lme4.
        J Stat Softw. 2015; 67: 1-48
        • Colizzi M.
        • Costa R.
        • Scaramuzzi F.
        • et al.
        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
        • Mueller A.
        • Zollver H.
        • Kronawitter D.
        • et al.
        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
        • Scherstén B.
        • Thulin T.
        • Kuylenstierna J.
        • et al.
        Clinical and biochemical effects of spironolactone administered once daily in primary hypertension. Multicenter Sweden study.
        Hypertension. 1980; 2: 672-679
        • Grundy S.M.
        • Stone N.J.
        • Bailey A.L.
        • et al.
        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
        • Fan W.
        • Philip S.
        • Granowitz C.
        • Toth P.P.
        • Wong N.D.
        Prevalence of US adults with triglycerides ≥ 150 mg/dl: NHANES 2007–2014.
        Cardiol Ther. 2020; 9: 207-213
        • Zwald M.L.
        • Akinbami L.J.
        • Fakhouri T.H.
        • Fryar C.D.
        Prevalence of low high-density lipoprotein cholesterol among adults, by physical activity: United States, 2011-2014.
        NCHS Data Brief. 2017; (Mar): 1-8
        • Virani S.S.
        • Morris P.B.
        • Agarwala A.
        • et al.
        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