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Cardiovascular disease during transition

The cohort study by Getahun and colleagues (2018, Annals of Internal Medicine) found in trans women on estrogen an increased risk of venous thromboembolism and ischaemic stroke.

Findings Getahun 2018

The cohort study by Getahun and colleagues (2018, Annals of Internal Medicine) found in trans women on estrogen an increased risk of venous thromboembolism and ischaemic stroke. In trans men on testosterone no clearly elevated cardiovascular risk was found in the same study, but follow-up was relatively short.

Dutch cohort data

The Amsterdam cohort study (Wiepjes et al. 2018) has followed a large group of transgender persons since 1972 and provides long-term data on cardiovascular and metabolic outcomes. The results support periodic cardiovascular risk assessment in long-term hormone treatment.

Recommendations

International guidelines recommend actively monitoring risk factors (blood pressure, lipids, glucose, smoking, weight) and, with elevated risk, adjusting the form of estrogen administration — for example by switching from oral to transdermal.