Cardiometabolic health and diabetes in transgender individuals receiving hormone therapy: considerations for healthcare

The number of people with gender dysphoria seeking hormone therapy has strongly increased over the past decade. While hormone therapy is known to induce large changes in body composition and shape, there is still uncertainty about concomitant metabolic effects and long-term safety with regard to cardiometabolic health. The aim of the current thesis was to further investigate the effects of hormone therapy in transgender individuals with regard to cardiometabolic health and some of its determinants. We concluded that the average effects of estrogens and testosterone on the studied parameters associated with increased cardiometabolic risk in both transgender women and transgender men were mild. On the contrary, the antiandrogen CPA however may have detrimental effects on cardiometabolic health and should only be prescribed with caution in cases with a relative contra-indication for other antiandrogen agents. Regarding the long-term safety of hormone therapy, the factors that explain the increased cardiovascular risk in transgender women remain unclear and need to be unraveled in future studies. Therefore, the cardiovascular health should be an integral part of the management of transgender people in both gender clinics and in primary care setting.