Impact of gender-affirming hormone therapy on cardiovascular function: a cross-sectional study

Silvia Ciancia; Simon D; Jeroen Vervalcke; Daniel Klink; Sjoen Guy T; Groote Katya De; Mosquera Laura Muino; Martine Cools

doi:10.1530/endoabs.110.P944

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Endocrine Abstracts (2025) 110 P944 | DOI: 10.1530/endoabs.110.P944

ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)

Impact of gender-affirming hormone therapy on cardiovascular function: a cross-sectional study

Silvia Ciancia ¹ , Simon D’hulst ² , Jeroen Vervalcke ³ , Daniel Klink ¹ , Guy T’ Sjoen ³ , Katya De Groote ² , Laura Muino Mosquera ² & Martine Cools ¹

Author affiliations

¹Ghent University Hospital, Department of Internal Medicine and Pediatrics, Service of Pediatric Endocrinology, Ghent, Belgium; ²Ghent University Hospital, Pediatric Cardiology Service, Department of Pediatrics, Ghent, Belgium; ³Ghent University Hospital, Endocrinology Service, Department of Internal Medicine, Ghent, Belgium

JOINT1274

Background: Cardiac parameters and cardiovascular risk (CVR) differ between sexes. Numerous studies have reported an increased CVR among adult transgender individuals, attributed to the metabolic changes associated with gender-affirming hormone therapy (GAHT) and lifestyle factors. However, the impact of GAHT on CV function remains poorly understood, especially if started during adolescence.

Methods: Echocardiographic evaluation was performed in 47 trans men (TM) and 6 trans women (TW), undergoing GAHT since 5-10 years. Assessments included diastolic and systolic cardiac function, cardiac and aortic diameters, and aortic stiffness index (SI). Additionally, CVR factors (such as glucose and lipid profiles, obesity, smoking and drinking habits, and hypertension) were analysed.

Results: Mean GAHT duration was 6.5 (±1.6SD) years in TM and 7.6 (±1.7SD) years in TW, median age was 23.4 (IQR 2.2) and 25.3 (IQR 2.7) years, respectively. Gonadal hormone suppression was obtained with progestins (TM) and cyproterone acetate (TW) in all but one individual per group (who received gonadotropin-releasing hormone agonist). Diastolic dysfunction grade 2 was diagnosed in one TM, while systolic function was normal in all individuals. A mildly dilated left ventricle (LV), after correction for body surface area (BSA), was observed in 6 TM when categorized by the experienced gender (EG), but only in 3 when categorized by the sex registered at birth (SRAB). LV mass/BSA mildly increased in 7 TM when categorized by SRAB, in none when categorized by EG. No correlation between LV mass/BSA and GAHT duration was found. Aortic diameters Z-scores where aligned more with EG than with SRAB in both groups. SI was 5.2 ± 2.3 SD in TM and 5.9 ± 1.9 SD in TW, (reference values 2.65 ± 0.55). Multiple regression analysis was conducted in TM, but not in TW due the small sample size, and showed a positive association only between SI and BMI (P-value=0.02).

Conclusions: GAHT for more than 5 years induces a shift in cardiac parameters towards the EG. SI is significantly increased in both TM and TW undergoing GAHT, representing an independent risk factor for CV disease and highlighting the need for careful long-term follow-up.

Key-words: GAHT, cardiovascular, aortic stiffness, echocardiography.