Recent research from Amsterdam UMC indicates that transgender women who use the hormone estradiol do not face a higher risk of heart attack or stroke compared to men in the broader Dutch population. This finding contrasts with previous studies that suggested otherwise, shedding new light on the cardiovascular health of transgender individuals. The study, which included data from over 4,000 transgender individuals, was published in the European Heart Journal.
The researchers believe that estradiol treatment, commonly administered to transgender women, may offer a protective effect on cardiovascular health. Transgender individuals often undergo hormone treatments to align their physical characteristics with their gender identity. For transgender women, this typically involves the use of estradiol, often alongside testosterone blockers. Martin den Heijer, professor of endocrinology at Amsterdam UMC, stated, “Earlier studies suggested a higher risk of heart attack and stroke for transgender women compared to people with the same birth sex. We did not really understand this. Now, however, we find no increased risk of heart and brain infarctions for transgender women who use estradiol.”
This large-scale study addresses a long-standing paradox in transgender health research. Previous investigations into cardiovascular disease in transgender populations were often limited in scale and duration. By analyzing a substantial dataset and comparing it with health data collected by Statistics Netherlands, the Amsterdam UMC study stands out as the largest in this domain to date.
Findings on Transgender Men
In contrast to the findings for transgender women, transgender men who utilize testosterone do exhibit an increased risk of heart attack and stroke when compared to women from the general Dutch population. This aligns with earlier research, which identified factors such as elevated blood pressure and unfavorable cholesterol levels associated with testosterone use. Mees van Zijverden, a physician-researcher at Amsterdam UMC, noted, “We know that testosterone use in transgender men can lead to slightly higher blood pressure and poorer cholesterol levels, which increases the risk of cardiovascular disease.”
Despite these findings, the researchers suggest that other factors beyond hormone use may contribute to the heightened risk. They explored lifestyle and socio-economic factors, including education and income levels, but these variables explained only a small portion of the increased cardiovascular risk. Van Zijverden emphasized the need for more extensive research to pinpoint the precise causes of this increased risk in transgender men.
Implications for Healthcare
As the population of transgender individuals utilizing hormone therapy continues to grow, understanding their specific health risks becomes increasingly crucial. Van Zijverden remarked, “The number of transgender people who use hormones is growing worldwide. This group is also getting older, meaning that cardiovascular disease will become an increasingly important point of attention in the future.”
The findings underscore the importance of monitoring cardiovascular health in transgender populations, particularly for transgender men who may be at higher risk. The researchers advocate for awareness among transgender men and healthcare providers regarding the potential risks, encouraging proactive measures to maintain a healthy lifestyle. Monitoring risk factors such as high blood pressure and cholesterol levels is essential for both transgender men and women.
As the discourse surrounding transgender health evolves, these insights from Amsterdam UMC pave the way for improved understanding and care tailored to the unique needs of transgender individuals. The study, titled “Transgender persons receiving gender-affirming hormone therapy: risk of acute cardiovascular events in a Dutch cohort study,” will be published in the European Heart Journal in 2025.
