Assessing the Effects of Hormone Therapy on Atherosclerotic Cardiovascular Risk in Transgender Adolescents

ABSTRACT

Purpose: Among U.S. high school students 2% identify as transgender. Adolescents (12-21 yo) with gender dysphoria may seek gender-affirming hormone therapy (GAHT). Previous studies have reported lower HDL among transgender youth before GAHT. The purpose of this study is to examine changes in lipids, glucose, blood pressure and BMI among transgender adolescents receiving GAHT for at least 2 years compared to baseline and normative values for adolescents. Methods: Chart review of 226 transgender adolescents (aged 12-24y) taking GAHT who received care at the Adolescent and Young Adult Medicine Clinic (2012-2021). Results: Limited 2-year data was available for 27 transgender females and 61 transgender males. Of the available data, about twice as many transgender males compared to transgender females had at least one risk factor at baseline and 2 years. Most common risk factors were low HDL (<40mg/dL), elevated systolic blood pressure (>130mmHg) and BMI (>=30). Conclusions: Transgender males, compared to transgender females, have more risk factors at baseline and 2 years in our single-site study. Due to the COVID-19 pandemic, the number of transgender adolescents with ASCVD risk factors is likely even greater because of increased sedentary time leading to increased weight gain. We recommend providers screen for risk factors and encourage physical activity and decreased sedentary behavior. Sources of Support University of Utah Department of Pediatrics;NIH Ruth L. Kirschstein National Research Service Award (NRS) institutional training grant (T35DK103596).