Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen

Daan M. Van Velzen, Alessia Paldino, Maartje Klaver, Nienke M. Nota, Justine Defreyne, G. Kees Hovingh, Abel Thijs, Suat Simsek, Guy T. Sjoen, Martin Den Heijer

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Context: The impact of gender-affirming hormone therapy (HT) on cardiometabolic parameters is largely unknown. Objective: The effects of 1 year of treatment with oral or transdermal administration of estrogen (plus cyproterone) and transdermal or IM application of testosterone on serum lipid levels and blood pressure (BP) were assessed in transgender persons. Design and Methods: In this prospective, observational substudy of the European Network for the Investigation of Gender Incongruence, measurements were performed before and after 12 months of HT in 242 transwomen and 188 transmen from 2010 to 2017. Results: Mean values are reported. In transmen, HT increased diastolic BP (2.5%; 95% CI, 0.6 to 4.4) and levels of total cholesterol (TC; 4.1%; 95% CI, 1.5 to 6.6), low-density lipoprotein-cholesterol (LDL-C; 13.0%; 95% CI, 9.2 to 16.8), and triglycerides (36.9%; 95% CI, 29.8 to 44.1); high-density lipoprotein-cholesterol levels decreased (HDL-C; 10.8%; 95% CI, 214.0 to 27.6). In transwomen, HT slightly decreased BP (systolic BP, 22.6%, 95% CI, 24.2 to 21.0; diastolic BP, 22.2%, 95% CI, 24.0 to 20.4) and decreased levels of TC (29.7%; 95% CI, 211.3 to 28.1), LDL-C (26.0%; 95% CI, 28.6 to 3.6), HDL-C (29.3%; 95% CI, 211.4 to 27.3), and triglycerides (210.2%; 95% CI, 214.5 to 25.9). Conclusion: Unfavorable changes in lipid profile were observed in transmen; a favorable effect was noted in transwomen. HT effects on BP were negligible. Long-term studies are warranted to assess whether and to what extent HT in trans individuals results in a differential effect on cardiovascular disease outcomes.

Original languageEnglish
Pages (from-to)1937-1947
Number of pages11
JournalJournal of Clinical Endocrinology and Metabolism
Volume104
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Cite this

Van Velzen, D. M., Paldino, A., Klaver, M., Nota, N. M., Defreyne, J., Kees Hovingh, G., ... Den Heijer, M. (2019). Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen. Journal of Clinical Endocrinology and Metabolism, 104(6), 1937-1947. https://doi.org/10.1210/jc.2018-02138
Van Velzen, Daan M. ; Paldino, Alessia ; Klaver, Maartje ; Nota, Nienke M. ; Defreyne, Justine ; Kees Hovingh, G. ; Thijs, Abel ; Simsek, Suat ; Sjoen, Guy T. ; Den Heijer, Martin. / Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen. In: Journal of Clinical Endocrinology and Metabolism. 2019 ; Vol. 104, No. 6. pp. 1937-1947.
@article{2ef95c9f67fc4279872a7e8bd309fbc3,
title = "Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen",
abstract = "Context: The impact of gender-affirming hormone therapy (HT) on cardiometabolic parameters is largely unknown. Objective: The effects of 1 year of treatment with oral or transdermal administration of estrogen (plus cyproterone) and transdermal or IM application of testosterone on serum lipid levels and blood pressure (BP) were assessed in transgender persons. Design and Methods: In this prospective, observational substudy of the European Network for the Investigation of Gender Incongruence, measurements were performed before and after 12 months of HT in 242 transwomen and 188 transmen from 2010 to 2017. Results: Mean values are reported. In transmen, HT increased diastolic BP (2.5{\%}; 95{\%} CI, 0.6 to 4.4) and levels of total cholesterol (TC; 4.1{\%}; 95{\%} CI, 1.5 to 6.6), low-density lipoprotein-cholesterol (LDL-C; 13.0{\%}; 95{\%} CI, 9.2 to 16.8), and triglycerides (36.9{\%}; 95{\%} CI, 29.8 to 44.1); high-density lipoprotein-cholesterol levels decreased (HDL-C; 10.8{\%}; 95{\%} CI, 214.0 to 27.6). In transwomen, HT slightly decreased BP (systolic BP, 22.6{\%}, 95{\%} CI, 24.2 to 21.0; diastolic BP, 22.2{\%}, 95{\%} CI, 24.0 to 20.4) and decreased levels of TC (29.7{\%}; 95{\%} CI, 211.3 to 28.1), LDL-C (26.0{\%}; 95{\%} CI, 28.6 to 3.6), HDL-C (29.3{\%}; 95{\%} CI, 211.4 to 27.3), and triglycerides (210.2{\%}; 95{\%} CI, 214.5 to 25.9). Conclusion: Unfavorable changes in lipid profile were observed in transmen; a favorable effect was noted in transwomen. HT effects on BP were negligible. Long-term studies are warranted to assess whether and to what extent HT in trans individuals results in a differential effect on cardiovascular disease outcomes.",
author = "{Van Velzen}, {Daan M.} and Alessia Paldino and Maartje Klaver and Nota, {Nienke M.} and Justine Defreyne and {Kees Hovingh}, G. and Abel Thijs and Suat Simsek and Sjoen, {Guy T.} and {Den Heijer}, Martin",
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Van Velzen, DM, Paldino, A, Klaver, M, Nota, NM, Defreyne, J, Kees Hovingh, G, Thijs, A, Simsek, S, Sjoen, GT & Den Heijer, M 2019, 'Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen' Journal of Clinical Endocrinology and Metabolism, vol. 104, no. 6, pp. 1937-1947. https://doi.org/10.1210/jc.2018-02138

Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen. / Van Velzen, Daan M.; Paldino, Alessia; Klaver, Maartje; Nota, Nienke M.; Defreyne, Justine; Kees Hovingh, G.; Thijs, Abel; Simsek, Suat; Sjoen, Guy T.; Den Heijer, Martin.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 104, No. 6, 01.06.2019, p. 1937-1947.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen

AU - Van Velzen, Daan M.

AU - Paldino, Alessia

AU - Klaver, Maartje

AU - Nota, Nienke M.

AU - Defreyne, Justine

AU - Kees Hovingh, G.

AU - Thijs, Abel

AU - Simsek, Suat

AU - Sjoen, Guy T.

AU - Den Heijer, Martin

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Context: The impact of gender-affirming hormone therapy (HT) on cardiometabolic parameters is largely unknown. Objective: The effects of 1 year of treatment with oral or transdermal administration of estrogen (plus cyproterone) and transdermal or IM application of testosterone on serum lipid levels and blood pressure (BP) were assessed in transgender persons. Design and Methods: In this prospective, observational substudy of the European Network for the Investigation of Gender Incongruence, measurements were performed before and after 12 months of HT in 242 transwomen and 188 transmen from 2010 to 2017. Results: Mean values are reported. In transmen, HT increased diastolic BP (2.5%; 95% CI, 0.6 to 4.4) and levels of total cholesterol (TC; 4.1%; 95% CI, 1.5 to 6.6), low-density lipoprotein-cholesterol (LDL-C; 13.0%; 95% CI, 9.2 to 16.8), and triglycerides (36.9%; 95% CI, 29.8 to 44.1); high-density lipoprotein-cholesterol levels decreased (HDL-C; 10.8%; 95% CI, 214.0 to 27.6). In transwomen, HT slightly decreased BP (systolic BP, 22.6%, 95% CI, 24.2 to 21.0; diastolic BP, 22.2%, 95% CI, 24.0 to 20.4) and decreased levels of TC (29.7%; 95% CI, 211.3 to 28.1), LDL-C (26.0%; 95% CI, 28.6 to 3.6), HDL-C (29.3%; 95% CI, 211.4 to 27.3), and triglycerides (210.2%; 95% CI, 214.5 to 25.9). Conclusion: Unfavorable changes in lipid profile were observed in transmen; a favorable effect was noted in transwomen. HT effects on BP were negligible. Long-term studies are warranted to assess whether and to what extent HT in trans individuals results in a differential effect on cardiovascular disease outcomes.

AB - Context: The impact of gender-affirming hormone therapy (HT) on cardiometabolic parameters is largely unknown. Objective: The effects of 1 year of treatment with oral or transdermal administration of estrogen (plus cyproterone) and transdermal or IM application of testosterone on serum lipid levels and blood pressure (BP) were assessed in transgender persons. Design and Methods: In this prospective, observational substudy of the European Network for the Investigation of Gender Incongruence, measurements were performed before and after 12 months of HT in 242 transwomen and 188 transmen from 2010 to 2017. Results: Mean values are reported. In transmen, HT increased diastolic BP (2.5%; 95% CI, 0.6 to 4.4) and levels of total cholesterol (TC; 4.1%; 95% CI, 1.5 to 6.6), low-density lipoprotein-cholesterol (LDL-C; 13.0%; 95% CI, 9.2 to 16.8), and triglycerides (36.9%; 95% CI, 29.8 to 44.1); high-density lipoprotein-cholesterol levels decreased (HDL-C; 10.8%; 95% CI, 214.0 to 27.6). In transwomen, HT slightly decreased BP (systolic BP, 22.6%, 95% CI, 24.2 to 21.0; diastolic BP, 22.2%, 95% CI, 24.0 to 20.4) and decreased levels of TC (29.7%; 95% CI, 211.3 to 28.1), LDL-C (26.0%; 95% CI, 28.6 to 3.6), HDL-C (29.3%; 95% CI, 211.4 to 27.3), and triglycerides (210.2%; 95% CI, 214.5 to 25.9). Conclusion: Unfavorable changes in lipid profile were observed in transmen; a favorable effect was noted in transwomen. HT effects on BP were negligible. Long-term studies are warranted to assess whether and to what extent HT in trans individuals results in a differential effect on cardiovascular disease outcomes.

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U2 - 10.1210/jc.2018-02138

DO - 10.1210/jc.2018-02138

M3 - Article

VL - 104

SP - 1937

EP - 1947

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 6

ER -