The Effect of Gender-Affirming Hormone Therapy on the Risk of Subclinical Atherosclerosis in the Transgender Population: A Systematic Review.

OBJECTIVE: The impact of gender-affirming hormone therapy (GAHT) on cardiovascular (CV) health is still not entirely established. A systematic review was conducted to summarize the evidence on the risk of subclinical atherosclerosis in transgender people receiving GAHT. METHODS: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data were searched in PubMed, LILACS, EMBASE, and Scopus databases for cohort, case-control, and cross-sectional studies or randomized clinical trials, including transgender people receiving GAHT. Transgender men and women before and during/after GAHT for at least 2 months, compared with cisgender men and women or hormonally untreated transgender persons. Studies reporting changes in variables related to endothelial function, arterial stiffness, autonomic function, and blood markers of inflammation/coagulation associated with CV risk were included. RESULTS: From 159 potentially eligible studies initially identified, 12 were included in the systematic review (8 cross-sectional and 4 cohort studies). Studies of trans men receiving GAHT reported increased carotid thickness, brachial-ankle pulse wave velocity, and decreased vasodilation. Studies of trans women receiving GAHT reported decreased interleukin 6, plasminogen activator inhibitor-1, and tissue plasminogen activator levels and brachial-ankle pulse wave velocity, with variations in flow-mediated dilation and arterial stiffness depending on the type of treatment and route of administration. CONCLUSIONS: The results suggest that GAHT is associated with an increased risk of subclinical atherosclerosis in transgender men but may have either neutral or beneficial effects in transgender women. The evidence produced is not entirely conclusive, suggesting that additional studies are warranted in the context of primary prevention of CV disease in the transgender population receiving GAHT. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, identifier CRD42022323757.

Does (mis)use of industrial liquid silicone implants interfere with bone mineral density in transgender women?

The effects of gluteal implants on bone mass remain unclear. Transgender women with ILS presented higher BMD in the hip compared with transgender women without implants, while no difference was observed in other sites. These results may be artifactual and suggest using spine/forearm sites for DXA in individuals with ILS. PURPOSE: The inappropriate use of industrial liquid silicone (ILS) injections for cosmetic purposes is practiced by some transgender women. The aim of this study was to evaluate the impact of gluteal ILS on femur BMD in transgender women. METHODS: A total of 46 trans women with and without ILS injection in the gluteal region were selected. All patients underwent clinical and hormonal evaluation, and bone mass was assessed by DXA. RESULTS: Bone mineral density (BMD) values were significantly higher in trans women with ILS (n = 23) in femoral neck and total femur when compared with trans women without implants (n = 23). Similar BMD was observed in other sites, such as lumbar spine and forearm. Good agreement was found in the evaluation of low BMD using spine/forearm or spine/femur in patients without implants (k = 0.744 and 1.000 for male and female reference database, respectively), but poor to fair index was found in patients with ILS implants (k = 0.330 and 0.646 for male and female reference database, respectively). CONCLUSIONS: In transgender women with ILS implants, poor to moderate agreement was found on BMD when comparing lumbar spine/femur DXA with an alternative site to the femur, depending on using male or female database. These results may be artifactual and suggest using spine/forearm sites for more accurate DXA assessments in trans women with ILS gluteal implants.