Studies suggest that the hormonal drugs taken by the rapidly growing number of transgender patients may increase the risk of fatal strokes and heart attacks by nearly sevenfold.
People assigned male at birth are usually prescribed estrogen, while biological females receive testosterone to achieve the physical attributes of the opposite sex.
The long-term risks of drugs in patients with gender dysphoria have not been well studied, and previous studies have focused on young women using hormone-based contraception or older women after hysterectomy or during menopause. was guessing.
Now, experts at the Mercy Catholic Medical Center in Derby, Pennsylvania, say that trans patients taking medication are up to seven times more likely to have an ischemic stroke compared to trans patients who are not prescribed it. I found that it was twice as high.
They were also nearly six times more likely to have a heart attack, the most serious type of heart attack, and five times more likely to have a pulmonary embolism, a blockage of an artery in the lungs.
The map above shows the 2020 transgender adult and child population across the United States, according to the Williams Institute at the University of California, Los Angeles. Estimates for children aged 13 to her 17 have doubled since 2017. The southern states are the most populous, followed by the states along the east coast.
A Massachusetts-based detransitioner known as Shape Shifter transitioned from male to female, but ran into a horrifying medical problem.Since then, he has deconverted and identifies as a gay man with a feminine appearance.
The study’s lead author and hospital resident, Dr. Ibrahim Ahmed, warned that making the medical transition “is not a risk-free endeavor.”
“It’s all about risks and benefits. Starting a transition is a big part of a person’s life and helps them feel more of themselves, but hormone replacement therapy also has many side effects.
Both estrogen and testosterone are known to increase blood clotting activity, which may explain the increased risk.
However, people on hormone replacement therapy also have higher rates of substance use disorders and hypothyroidism, both of which increase the risk of blood clots and cardiovascular problems.
The researchers emphasized that although the risk was up to seven times higher, the absolute risk was still small.
One limitation of this study was that it only accounted for whether individuals had ever used any type of hormone replacement therapy.
To better inform clinical decisions, the researchers say it would be helpful to assess whether duration of treatment, age at initiation, or type of hormone therapy used affects risk.
An estimated 1.6 million Americans age 13 and older identify as transgender. University of California, Los Angeles Report – This number has skyrocketed in recent years as acceptance of gender dysphoria grows.
Gender-affirming care for adults and adolescents in the United States can include many medical, behavioral, and social changes beyond surgery.
For adolescents who have not yet reached puberty, pubertal-blocking drugs can suppress the release of the sex hormones testosterone and estrogen and stop the development of secondary sexual characteristics such as breasts and facial hair. increase.
Transgender adults and adolescents can also start hormone therapy, whether or not their natural puberty is disturbed. This essentially kicks off puberty of gender identity.
These hormones can be taken as pills, patches, or gels and taken continuously throughout adulthood or until desired physical characteristics are achieved.
Surgical options include facial, chest, and genital alteration procedures, which are usually the last steps in the transition process.
Originally from Glasgow, Scotland, Sinead Watson lived as a man at the age of 23 and underwent a double mastectomy, but at 27 he realized he had made a terrible mistake and stopped the transition at 28. . She took to social media this week to speak out. About the widespread harassment from the transgender community she left: “I was raped and had death threats,” Watson snapped a picture of her earlier this year. It was called Shaw.”
In the latest study, due to be presented at the American College of Cardiology research session on Thursday, researchers collected data from 21,000 people with gender dysphoria.
Data were collected in 2019, but members of the sample had started treatment earlier.
Researchers used medical record data to identify teenagers who had a cardiac event after starting treatment.
Of that group, 1,675 received hormone therapy.
Hormone therapy is an umbrella term for drugs that increase the levels of hormones naturally produced by people of the opposite sex, giving a person desirable characteristics.
Transgenders usually receive testosterone and transwomen receive estradiol.
This drug has long been used to treat low testosterone in men and problems related to fertility and menopause in some women.
In recent years, off-label use has surged as physicians began prescribing it to transitional patients.
Researchers found that across the study population, people who suffered from gender dysphoria and were treated were 7.15 times more likely to suffer an ischemic stroke than those who did not.
It occurs when a blood clot blocks the vital arteries that blood uses to travel to the brain. About 17% of these events result in death.
Pulmonary embolism, where blood clots and arteries block the flow of blood to the lungs, was also 4.92 times more common among those taking hormone therapy.
One of the deadliest forms of heart attack, myocardial infarction, also caused by blood clots, is 5.9 times more common in people on hormone therapy.
Although some have disputed this association, large studies have shown an association between pill hormone therapy and an increased risk of blood clots, especially in women.
2019 study by UK researchers Women who received oral treatment had a 58% increased risk of developing potentially fatal blood clots.
The same study did not find other treatments to have a significant effect on risk.
“I’m curious if the method of administration affects the results,” Dr. Ahmed said.
“Does one method of administering hormone replacement therapy have lower or better cardiovascular outcomes? If so, that should be the focus of how we deliver hormone replacement therapy to these patients.” is.
However, external factors may be influencing.
Transgender people are more likely to suffer from mental health problems such as depression and anxiety, and are also associated with an increased risk of this cardiovascular problem.
This can be controlled by using only patients suffering from gender dysphoria in the study, as this study did.
Still, Dr. Ahmed wants doctors to do more to screen patients and make them aware of potential risks before undertaking these treatments.
“I’m curious if the method of administration affects the results,” he said.
“Does one method of administering hormone replacement therapy have lower or better cardiovascular outcomes? If so, that should be the focus of how we deliver hormone replacement therapy to these patients.” is.
