Transgender Hormone Treatment Connected to High Blood Pressure Changes

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Transgender individuals treated with gender-affirming hormonal agent treatment show unique modifications in blood pressure that start right after treatment initiation and do not decrease over years of treatment, according to the largest and longest observational research study to date to look at the issue.

“Lots of doctors may not be aware of the changes to blood pressure in trans patients who start hormonal agent treatment,” senior author Michael S. Irwig, MD, director of transgender medicine at Beth Israel Deaconess Medical Center in Boston, Massachusetts, told Medscape Medical News.

“The take-away message for doctors is to keep track of high blood pressure both prior to and after beginning hormonal agent therapy in transgender patients, as over a third of transgender individuals had stage 1 hypertension before starting hormonal agent treatment, and lots of had their blood pressure boost after beginning hormone therapy.”

Mean High Blood Pressure Boosts in Transgender Males, Reduces in Women

In the study, released today in the journal High blood pressure, Katherine Banks, MD, of The George Washington School of Medicine & Health Sciences, Washington, DC, and colleagues, followed 470 transgender adult patients for up to 5 years.

The mean systolic blood pressure levels in transgender female patients (male at birth) significantly reduced compared with baseline within a few months of them beginning gender-affirming hormonal agent treatment.

Alternatively, the systolic high blood pressure levels in transgender males (females at birth) who were treated with testosterone increased over the exact same duration.

There were no substantial changes in the groups in terms of diastolic blood pressure, constant with other research studies.

“Our study is the first to explain the time course of the blood pressure impacts of gender-affirming hormonal agent treatment and to compare the rates of elevated blood pressure and stage 1 and phase 2 hypertension utilizing blood pressure readings from gender-diverse individuals pre- and post-gender-affirming hormone therapy,” the authors note.

Gender-affirming hormone therapy– which has been prescribed to transgender clients for more than 25 years– typically involves a mix of estrogen and an anti-androgen for males transitioning to female, while the treatment for those transitioning to male typically only involves testosterone.

The therapy has actually previously been connected to different cardiac effects, with proof showing transgender men have as much as a 5-times greater danger of heart attack vs cisgender ladies, the authors keep in mind.

Although the American Heart Association provided a 2020 Scientific Statement attending to the cardiovascular disease threat, proof on the results particularly on blood pressure in transgender clients has actually been inconsistent.

For the brand-new research study, Banks and associates registered 247 transgender women and 223 transgender males who were treated in between 2007 and 2015 at two medical centers in Washington, DC. Of the individuals, who had a mean age of 27.8, about 27% were non-White and 16% were Latinx.

They had blood pressure measurements taken at standard and at follow-up medical gos to for up to 57 months following the initiation of gender-affirming hormonal agent therapy.

Over the follow-up duration, the transgender women had reductions in mean systolic high blood pressure of 4.0 mm Hg within 2 to 4 months of starting hormone treatment (P