Cardiovascular risk factors in transgender adolescents before and during puberty suppression and sex steroid therapy

Sunnergren Kjersti Kvernebo; Pernille Norup; Mette Haahr; Annamaria Giraldi; Anne Katrine Pagsberg; Peter Christiansen; Lise Aksglaede; Line Cleemann; Anders Juul; Katharina M. Main

doi:10.1530/endoabs.110.OC13.4

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Endocrine Abstracts (2025) 110 OC13.4 | DOI: 10.1530/endoabs.110.OC13.4

ECEESPE2025 Oral Communications Oral Communications 13: Adrenal and Cardiovascular Endocrinology Part 2 (6 abstracts)

Cardiovascular risk factors in transgender adolescents before and during puberty suppression and sex steroid therapy

Kjersti Kvernebo Sunnergren ^1,2 , Pernille Norup ^3,4 , Mette Haahr ^4,5 , Annamaria Giraldi ^5,6 , Anne Katrine Pagsberg ^6,7 , Peter Christiansen ^3,4 , Lise Aksglaede ^3,4 , Line Cleemann ^3,4 , Anders Juul ^3,4,6 & Katharina M. Main ^3,4,6

Author affiliations

¹Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Department of Pediatrics, Göteborg Pediatric Growth Research Center (GP-GRC), Gothenburg, Sweden; ²Ryhov County Hospital, Region Jönköping County, Department of Pediatrics, Jönköping, Sweden; ³Copenhagen University Hospital—Rigshospitalet, Department of Growth and Reproduction, Copenhagen, Denmark; ⁴International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark; ⁵Mental Health Center, Copenhagen University Hospital, Sexological Clinic, Copenhagen, Denmark; ⁶University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark; ⁷Mental Health Services, Capital Region of Denmark, Child and Adolescent Mental Health Centre, Hellerup, Denmark

JOINT663

Background: Transgender adolescents may be treated with gonadotropin-releasing hormone analog (GnRHa) and sex steroids. Hormone therapy (HT) may affect cardiovascular risk factors such as overweight, obesity and dyslipidemia.

Objective: To evaluate weight, body mass index (BMI), and lipid profiles at start and during HT in a Danish national cohort of transgender adolescents who started HT before 18 years of age.

Patients and methods: The cohort consisted of 164 trans boys and 55 trans girls. GnRHa was initiated before (n=102 trans boys and n=43 trans girls) or simultaneously with testosterone (n=62) or estradiol (n=12). Weight, BMI and lipid profiles were assessed at routine visits. Changes in the estimate (95% confidence intervals) were analyzed for weight standard deviation score (SDS), BMI SDS, and lipid profiles, using mixed model analyses.

Results: Before HT, overweight (BMI ≥1SDS) and obesity (BMI ≥2SDS) were found in 29.9% and 22.0% of the trans boys and in 5.7% and 5.7% of the trans girls, respectively. Lipids profiles outside normal range were found in both trans boys and girls; total cholesterol ≥5.0 mmol/l (12.5% and 6.1%), low-density lipoprotein (LDL) ≥3.0 mmol/l (20.4% and 8.2%), high-density lipoprotein (HDL) ≤1.0 mmol/l (10.3% and 18.4%), and triglycerides ≥2.0 mmol/l (4.1% and 6.3%), respectively. During GnRHa monotherapy, weight SDS declined after one year of treatment (n=56, -0.2(-0.3–-0.0), P=0.017) in trans boys and after one (n=28, -0.3(-0.5–-0.1), P=0.010) and two years (n=9, -0.4(-0.7–-0.1, P=0.013) in trans girls. No consistent trends were observed in BMI SDS or the lipid profiles. During sex steroid therapy, weight SDS declined in trans boys only; after two (n=70, -0.4(-0.6–-0.2), P <0.001) and three years of treatment (n=13, -0.7(-1.2–-0.2), P=0.006). No consistent trends were observed in BMI SDS. During the first three years of sex steroid therapy, HDL decreased (n=104, -0.1(-0.2–-0.1), P <0.001, n=62, -0.2(-0.2–-0.1), P <0.001, n=25, -0.2(-0.3–-0.1), P <0.001), and triglycerides increased (n=104, 0.2(0.1–0.4), P=0.003, n=62, 0.3(0.2–0.5), P <0.001, n=26, 0.4(0.2–0.6), P=0.002) in trans boys, while HDL increased in trans girls; (n=28, 0.3(0.1–0.4), P <0.001, n=19, 0.3(0.2–0.5), P <0.001, n=7, 0.4(0.0–0.7), P=0.038).

Conclusion: The prevalence of overweight, obesity and dyslipidemia before HT was high compared with normal range. BMI SDS did not deteriorate during HT, but dyslipidemia worsened slightly during testosterone treatment. The results suggest that some transgender adolescents may benefit from lifestyle interventions and treatment of dyslipidemia to reduce the long-term cardiovascular risk.