Effects of cross-sex hormones on natal females' blood pressure

(17 Posts)
PotholeHellhole Fri 23-Apr-21 00:15:48

Title of article Transgender Therapy Tied to Blood Pressure Changes

Key quotes regarding the effects on study participants born female

"April 19, 2021 --Transgenderpeople treated with gender-affirminghormone therapyshow distinctive changes inblood pressurethat begin soon after treatment starts and do not ease over years of treatment, according to the largest and longest observational study to look at the issue."

...

"The take-away message for physicians is to monitor blood pressure both before and after starting hormone therapy in transgender patients, as over a third of transgender individuals had stage 1 hypertension before startinghormone therapy, and many had their blood pressure increase after starting hormone therapy."

...

"In thestudy, published this weekin the journalHypertension, Katherine Banks, MD, of the George Washington School of Medicine & Health Sciences in Washington, D.C., and colleagues, followed 470 transgender adult patients for up to 5 years."

...

"the systolic blood pressure levels in transgender males who were treated with testosterone increased"

...

"The therapy has previously been linked to various heart problems, with evidence showing transgender men have as much as a 5-times greater risk ofheart attackvs.cisgenderwomen, the authors note."

...

"Although the American Heart Association issued a2020 Scientific Statementaddressing the heart disease risk, evidence on the effects specifically on blood pressure in transgender patients has been inconsistent."

"For the new study, Banks and colleagues enrolled 247 transgender females and 223 transgender males who were treated between 2007 and 2015 at two medical centers in Washington. Of the patients, who had an average age of 27.8, about 27% were non-White and 16% were Latino."

"They had blood pressure measurements taken at the beginning of the study and at follow-up visits for up to 57 months after the start of gender-affirming hormone therapy.

"As many as 40% of transgender men had stage 1 hypertension after 11 to 21 months of hormone therapy."

Full source here: www.webmd.com/a-to-z-guides/news/20210419/transgender-therapy-tied-to-blood-pressure-changes

OP’s posts: |
PotholeHellhole Fri 23-Apr-21 00:43:42

Sorry, I'll repost that with the spaces in.

"Transgender people treated with gender-affirming hormone therapy show distinctive changes in blood pressure that begin soon after treatment starts and do not ease over years of treatment, according to the largest and longest observational study to look at the issue."

...

"The take-away message for physicians is to monitor blood pressure both before and after starting hormone therapy in transgender patients, as over a third of transgender individuals had stage 1 hypertension before starting hormone therapy, and many had their blood pressure increase after starting hormone therapy."

...

"In the study, published this week in the journal Hypertension, Katherine Banks, MD, of the George Washington School of Medicine & Health Sciences in Washington, D.C., and colleagues, followed 470 transgender adult patients for up to 5 years."

...

"the systolic blood pressure levels in transgender males who were treated with testosterone increased"

...

"The therapy has previously been linked to various heart problems, with evidence showing transgender men have as much as a 5-times greater risk of heart attack vs.cisgender women, the authors note."

...

"Although the American Heart Association issued a 2020 Scientific Statement addressing the heart disease risk, evidence on the effects specifically on blood pressure in transgender patients has been inconsistent."

"For the new study, Banks and colleagues enrolled 247 transgender females and 223 transgender males who were treated between 2007 and 2015 at two medical centers in Washington. Of the patients, who had an average age of 27.8, about 27% were non-White and 16% were Latino."

"They had blood pressure measurements taken at the beginning of the study and at follow-up visits for up to 57 months after the start of gender-affirming hormone therapy.

"As many as 40% of transgender men had stage 1 hypertension after 11 to 21 months of hormone therapy."

Full source here:www.webmd.com/a-to-z-guides/news/20210419/transgender-therapy-tied-to-blood-pressure-changes

OP’s posts: |
DeRigueurMortis Fri 23-Apr-21 01:09:53

I think we will see more and more data coming to light that evidences the long term effects of transition on the human body.

I'm frankly bemused by the concept that it's possible to "cheat" your sex via medication without consequence.

The suppression and/or imposition of extremely powerful hormones is not a small thing yet I feel it's something that's become diminished.

"Taking T" for example sounds as benign as tea with your grandmother.

"Pausing puberty" sounds reasonable until
you understand the potential side effects not only of the drugs, but also the impact that the withdrawal of puberty brings both physically and mentally (and no - you can't go through the puberty "of your choice" on CSH's so it's either through your birth sex or not at all).

There should be far more investigation into medium and long term outlooks for people who choose to transition.

EmbarrassingAdmissions Fri 23-Apr-21 05:20:18

It's interesting to see the impacts on systolic blood pressure/hypertension with such a relatively young cohort of people.

Our study found that within 2 to 4 months of starting GAHT, mean systolic blood pressure was lower in the trans feminine group by 4.0 mm Hg (P<0.0001) and higher in the trans masculine group by 2.6 mm Hg (P=0.02).

I note the authors close their abstract with a comment about older age-groups:

Further research is needed on the effects of [Gender Affirming Hormone Therapy] GAHT in older gender-diverse individuals and on optimal formulations of GAHT.

Paywall: www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16839

References to stage 1 hypertension: Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89

NHS doesn't name it here - it's so-called pre-hypertension as a risk factor for later hypertension (about which I have mixed feelings): www.nhs.uk/conditions/high-blood-pressure-hypertension/

AnyOldPrion Fri 23-Apr-21 05:35:29

Another reminder that transition is not medically a zero sum game and should only be considered (assuming sound evidence exists that it is beneficial in some circumstances) as a last resort and not a first line.

jay55 Fri 23-Apr-21 06:20:00

It's no real surprise, given the health issues and early deaths suffered by eastern block athletes.

EdgeOfACoin Fri 23-Apr-21 06:45:19

I found the language in that report confusing and made it hard to follow. Is a "transgender male" a ftm transitioner? Meaning the word "male" can now be applied to a biological female?

Also, seems a strange way of recording ethnicity - white, non-white and Latino hmm

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chocolateorangeinhaler Fri 23-Apr-21 06:47:48

Not sure about this. I've always been told that systolic is not as important as diastolic when reading nibp.
How does this compare to a control group or other group taking different meds? There is also the white coat syndrome at play where even healthy people have elevated readings when a medical professional approaches to take the reading. NIBP is not hugely accurate depending on how it was taken, what type of machine it was taken or the skill of the operative.

EmbarrassingAdmissions Fri 23-Apr-21 07:14:55

EdgeOfACoin

I found the language in that report confusing and made it hard to follow. Is a "transgender male" a ftm transitioner? Meaning the word "male" can now be applied to a biological female?

Also, seems a strange way of recording ethnicity - white, non-white and Latino hmm

Yes, a transgender male is a transman.

There are no good ways of recording ethnicity so the categories of white, non-white and Latino make sense in the US context of this observational study which was specifically in a Federally Qualified Health Center and an academic endocrinology practice, both in Washington DC

'Ive always been told that systolic is not as important as diastolic when reading nibp.
How does this compare to a control group or other group taking different meds?

It's usually systolic that attracts more publicity.

I'd hope that the authors provide a full discussion of potential confounders in the full paper (linked above but I don't have access to it). I have no idea what they used for a comparator data set for population matching.

Tibtom Fri 23-Apr-21 07:15:55

I agree the language is confusing and seems inconsistent. You are unsure about the sex of the participants. I can understand having latino as a group in America but wasn't sure if they were part of the white or non white group.
There weren't controls but it was a longitudinal study so the results showed changes against baseline. If white coat syndrome was at play then it would have to have been something that didn't initially exist in the group but developed over time.

PotholeHellhole Fri 23-Apr-21 07:36:52

Very confusing language, yes.

In order to work out at any time in the article,whichstudy participants were being discussed, I had to check the details of the medication prescribed in the prior paragraph. So transgender males had to mean transmen because it specified they were being given testosterone therapy.

OP’s posts: |
EmbarrassingAdmissions Fri 23-Apr-21 07:47:33

latino as a group in America but wasn't sure if they were part of the white or non white group.

For the purposes of this study, they're a 3rd classification.

Shizuku Fri 23-Apr-21 11:59:43

So this is something we need to keep an eye on in trans men, but the benefits to trans women are clear:

"Transgender females showed as much as a 47% decrease in the rate of stage 2 hypertension and the rate declined further to 8% at 11 to 21 months, suggesting a protective effect of the treatment."

ArabellaScott Fri 23-Apr-21 12:16:59

Well, here's an article to further confuse matters:

www.heart.org/en/news/2019/10/28/how-does-hormone-therapy-affect-heart-health-in-transgender-people

'After reviewing dozens of studies, the researchers concluded the use of estrogen by transgender women may be associated with an increased risk of heart attack and ischemic stroke. On the other hand, the use of testosterone by transgender men did not seem to increase cardiovascular risk.

Dr. Paul Connelly, one of the study's researchers, said those findings were somewhat unexpected, because estrogen is thought to reduce inflammation and have a protective effect on the vascular system, while testosterone is thought to have a more mixed effect with some negative impact on cardiovascular health.'

EmbarrassingAdmissions Fri 23-Apr-21 12:24:14

ArabellaScott

Well, here's an article to further confuse matters:

www.heart.org/en/news/2019/10/28/how-does-hormone-therapy-affect-heart-health-in-transgender-people

'After reviewing dozens of studies, the researchers concluded the use of estrogen by transgender women may be associated with an increased risk of heart attack and ischemic stroke. On the other hand, the use of testosterone by transgender men did not seem to increase cardiovascular risk.

Dr. Paul Connelly, one of the study's researchers, said those findings were somewhat unexpected, because estrogen is thought to reduce inflammation and have a protective effect on the vascular system, while testosterone is thought to have a more mixed effect with some negative impact on cardiovascular health.'

If anyone wants to look at the full paper, it's Open Access:

www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.13080

It's a review of a range of studies including various observational data sets and collections of healthcare records. There is a diversity of notional categorisations by race and age as well as various biomarkers.

ArabellaScott Fri 23-Apr-21 12:43:39

Thanks, Embarrasing.

ShastaBeast Fri 23-Apr-21 13:03:15

Women with PCOS are more prone to high BP due to high testosterone levels.

I had a health issue which is rare in under 60s and is linked to blood pressure and high cholesterol. The consultant asked if I had high testosterone. My levels are only just over the top end of normal. The issue could lead to losing my sight in one eye, and heart attacks and strokes if I’m unlucky, despite a healthy BMI, no smoking/alcohol. Clearly women aren’t meant to have high testosterone, even if it is naturally occurring due to PCOS.

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