The Role of Hormones in Cardiovascular Health
Hormones such as oestrogen, testosterone, and progesterone play significant roles in cardiovascular health:
- Oestrogen is considered protective against heart disease in cisgender women before menopause.
- Testosterone levels have been linked with cardiovascular risks, but the evidence is not conclusive. Some studies suggest that low testosterone levels might increase the risk of heart disease in men.
- Progesterone may impact blood clot risks, but bioidentical progesterone is considered safer than synthetic progestins.
Understanding the Risks
- Heart Attacks and Strokes: hormone therapy may slightly change the risk of heart attacks and strokes, but the current evidence suggests that the risk increase is minimal.
- Blood Clots: oestrogen, when taken orally, can increase the risk of blood clots. The risk is lower with transdermal (through the skin) applications and with bioidentical formulations.
Positive Perspective on Hormone Use
Natural Hormone Production: people with heart disease or a history of blood clots are not typically required to suppress their natural hormones. Choosing a hormone profile that aligns with a person’s gender identity can be safely managed even in the presence of these conditions.
Managing Risks: people on hormone therapy should manage cardiovascular risk factors such as smoking, high blood pressure, and cholesterol.
Special Considerations for Antiandrogens
Spironolactone and Heart Disease: we don't recommend spironolactone to people with heart disease because of its potential for drug interactions, and effects on electrolyte balance and blood pressure. If needed, it can still be taken with careful monitoring.
Recommendations from WPATH and the Endocrine Society
Both the World Professional Association for Transgender Health (WPATH) and the Endocrine Society provide guidelines for gender-affirming hormone therapy:
Individualised Care: individualised treatment plans and careful monitoring for those with pre-existing cardiovascular conditions to help reduce risks.
Informed Decision-Making: make sure people are informed about the potential risks and benefits of having or not having hormone therapy.
Regular Monitoring: regular monitoring and any adjustment of hormone therapy is important to maintain normal levels of hormones.
FAQs
Can I commence gender affirming hormone treatment if I have coronary heart disease or heart failure?
Having coronary heart disease or heart failure won't stop you from accessing gender affirming hormone treatment.
Heart attacks, strokes, and blood clots do not have a singular cause. These can include high blood pressure, high cholesterol, smoking, diabetes, being overweight, and inactivity. Your overall risk can be decreased by addressing any of these risk factors.
We recommend that you continue to attend your doctor and cardiologist so that your treatment for your coronary heart disease or heart failure can be monitored and optimised.
I have a family history of cardiovascular disease. Can I commence gender affirming hormone treatment?
Having a family history of cardiovascular disease won't stop you from accessing gender affirming hormone treatment.
Heart attacks, strokes, and blood clots do not have a singular cause. These can include high blood pressure, high cholesterol, smoking, diabetes, being overweight, and inactivity. Your overall risk can be decreased by addressing any of these risk factors.
We recommend that you have annual health checks to monitor your blood pressure, cholesterol, smoking status, and/or diabetes.
Can testosterone cause blood clots?
There is some evidence that gender affirming hormone treatment can increase the risk of blood clots. Blood clots do not have a singular cause. These can include high blood pressure, high cholesterol, smoking, diabetes, being overweight, and inactivity. Your overall risk can be decreased by addressing any of these risk factors.
The overall risk of blood clots can be decreased by addressing these risk factors.