Flávia Siqueira Cunha, Tania Aparecida Sartori Sanchez Bachega, Elaine Maria Frade Costa, Vinicius Nahime Brito, Leonardo Azevedo Alvares, Valéria Aparecida Costa-Hong, Renata Gomes Sanches Verardino, Maria Helena Palma Sircili, Berenice Bilharinho de Mendonça, Luiz Aparecido Bortolotto, Sorahia Domenice
Journal of the Endocrine Society, Volume 7, Issue 5, May 2023, bvad040
https://doi.org/10.1210/jendso/bvad040
The effects of androgen therapy on arterial function in transgender men (TM) are not fully understood, particularly concerning long-term androgen treatment.
To evaluate arterial stiffness in TM receiving long-term gender-affirming hormone therapy by carotid-femoral pulse wave velocity (cf-PWV).
A cross-sectional case-control study at the Gender Dysphoria Unit of the Division of Endocrinology, HC-FMUSP, Sao Paulo, Brazil. Thirty-three TM receiving intramuscular testosterone esters as regular treatment for an average time of 14 ± 8 years were compared with 111 healthy cisgender men and women controls matched for age and body mass index. Aortic stiffness was evaluated by cf-PWV measurements using Complior device post-testosterone therapy. The main outcome measure was aortic stiffness by cf-PWV as a cardiovascular risk marker in TM and control group.
The cf-PWV after long-term testosterone therapy was significantly higher in TM (7.4 ± 0.9 m/s; range 5.8–8.9 m/s) than in cisgender men (6.6 ± 1.0 m/s; range 3.8–9.0 m/s, P < .01) and cisgender women controls (6.9 ± .9 m/s; range 4.8–9.1 m/s, P = .02). The cf-PWV was significantly and positively correlated with age. Analysis using blood pressure as a covariate showed a significant relationship between TM systolic blood pressure (SBP) and cf-PWV in relation to cisgender women but not to cisgender men. Age, SBP, and diagnosis of hypertension were independently associated with cf-PWV in the TM group.
The TM group on long-term treatment with testosterone had higher aging-related aortic stiffening than the control groups. These findings indicate that aortic stiffness might be accelerated in the TM group receiving gender-affirming hormone treatment, and suggest a potential deleterious effect of testosterone on arterial function. Preventive measures in TM individuals receiving testosterone treatment, who are at higher risk for cardiovascular events, are highly recommended.
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