Research Reveals Elevated Cardiovascular and Metabolic Risk in Transgenders

At the Annual Meeting of the European Association for the Study of Diabetes held in Hamburg from October 2nd to 6th, Dr. Dorte Glintborg from the Department of Endocrinology at Odense University Hospital in Denmark presented the latest data on metabolic issues faced by transgender individuals. While the relationship between diabetes and transgender identity remains uncertain, evidence continues to mount suggesting that transgender individuals are at a higher risk of cardiovascular disease. 

Dr. Glintborg explained that this increased risk of cardiovascular disease does not necessarily align with the expected risk factors associated with diabetes. For transgender men, who were assigned female at birth (AFAB), the use of testosterone often results in increased lean body mass, potentially protecting them against a heightened risk of diabetes. 

On the other hand, transgender women, who were assigned male at birth (AMAB), undergo hormone treatments that increase fat mass and reduce lean body mass. This shift in body composition, particularly increased estrogen levels, is typically linked to a higher risk of autoimmune diseases and inflammation.

Some studies have suggested a higher risk of type 2 diabetes in transgender women, but this has not been consistently confirmed. Dr. Glintborg emphasized that various factors beyond body fat, lean mass, and muscle mass could influence the risk of vascular and metabolic diseases in transgender populations. More long-term data is needed to comprehensively understand these factors.

It has also been proposed that mental support as a part of transgender care might alleviate minority stress and protect against the development of cardiovascular disease. Additionally, lifestyle changes, such as increased physical activity in transgender men, may help protect against type 2 diabetes. However, the field is still rapidly evolving, and large study cohorts are lacking to provide more definitive conclusions. 

Dr. Glintborg discussed several studies highlighting the elevated cardiovascular risk faced by transgender individuals. One such study, which she and her colleagues conducted and published in The European Journal of Endocrinology, demonstrated that compared to cisgender individuals, transgender men and women had an increased risk of cardiovascular disease.

This study used Danish health registers to determine cardiovascular outcomes, and it included a cohort of 2,671 transgender individuals, with 1,270 AFAB individuals (transgender men) and 1,401 AMAB individuals (transgender women). 

The control population, consisting of 26,710 individuals, was matched to the transgender cohort by age. Notably, the study cohort was relatively young, with a median age of 22 years for AFAB individuals and 26 years for AMAB individuals. Hypertension and dyslipidemia were the most common cardiovascular problems identified. 

Over a mean follow-up period of 4.5 years for AFAB individuals and 5.7 years for AMAB individuals, both transgender men and women exhibited significantly higher risks of cardiovascular disease compared to control groups. 

The analysis suggested that around one-third of the increased cardiovascular risk in transgender males could be attributed to gender-affirming hormone treatment (GAHT), aligning with previous research linking hormones like testosterone to higher cardiovascular risk. However, for transgender females, the use of GAHT, involving estrogen and testosterone blockers, could not explain the increased cardiovascular risk. 

It’s important to note that this study was register-based and did not allow for an investigation into the influence of factors such as BMI, family history of cardiovascular disease, minority stress, and lifestyle factors like diet, smoking, and exercise. Therefore, the authors concluded that more research is needed to understand the mechanisms underlying adverse metabolic outcomes in transgender individuals. 

Dr. Glintborg also highlighted the impact of increased demand for transgender care services in many European and Western countries, leading to delays in patient appointments and self-medication by trans women using cyproterone acetate to mitigate hormone therapy side effects. Some studies have suggested a higher risk of hypertension in trans women using this drug, and Dr. Glintborg stressed the need for investigating its potential association with cardiovascular disease. 

In conclusion, the presentation by Dr. Glintborg emphasized the need for further research into the complex relationship between transgender identity, metabolic issues, and cardiovascular health. It is crucial to explore the effects of different medication regimens on transgender individuals’ health and to balance the potential benefits of gender-affirming hormone therapy on mental health with its potential impact on cardiovascular markers in this minority group.

Doctors should also prioritize discussing the importance of physical activity, weight management, and smoking cessation with their transgender patients who may be at risk for metabolic issues and cardiovascular disease. 

News Reference  

Press News Org, “Evidence on increased rates of diabetes unclear in trans people, but evidence on higher rates of cardiovascular disease clear” Evidence on increased rates of diabetes unclear in trans people, but evidence on higher rates of cardiovascular disease clear (press-news.org).