Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
J Hypertens. 2021 Feb 1;39(2):223-230. doi: 10.1097/HJH.0000000000002632.
Gender-affirming hormone therapy (GHT) is utilized by people who are transgender to align their secondary sex characteristics with their gender identity. Data relating to cardiovascular outcomes in this population are limited. We aimed to review the impact of GHT on the blood pressure (BP) of transgender individuals.
We searched PubMed/MEDLINE, SCOPUS and Cochrane Library databases for articles published relating to the BP of transgender adults commencing GHT. Methodological quality was assessed via the 'Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group'.
Six hundred articles were screened, of which 14 studies were included in this systematic review encompassing 1309 individuals (∼50% transgender men and women) treated with GHT between 1989 and 2019. These articles were all pre-post observational studies without control groups. Mean ages ranged between 23.0-36.7 years (transgender men) and 25.2-34.8 years (transgender women). Interventions were diverse and included oral, transdermal and injectable hormonal preparations with 4 months to 5 years follow-up. Most studies in transgender men did not demonstrate a change in BP, whereas transgender women on GHT demonstrated both increases and decreases in SBP. These studies were heterogenous with significant methodological limitations and only two were determined to have a good quality rating.
There is currently insufficient data to advise the impact of GHT on BP in transgender individuals. Better quality research is essential to elucidate whether exogenous sex hormones modulate BP in transgender people and whether this putative alteration infers poorer cardiovascular outcomes.
性别肯定激素疗法（GHT）被跨性别者用于使他们的第二性特征与他们的性别认同相一致。关于该人群心血管结局的数据有限。我们旨在回顾 GHT 对跨性别个体血压（BP）的影响。
我们在 PubMed/MEDLINE、SCOPUS 和 Cochrane 图书馆数据库中搜索了与开始 GHT 的成年跨性别者 BP 相关的文章。通过“无对照组的前后（预-后）研究质量评估工具”评估方法学质量。
筛选出 600 篇文章，其中 14 项研究被纳入本系统综述，共纳入 1309 名（约 50%的跨性别男性和女性）接受 GHT 治疗的个体，治疗时间为 1989 年至 2019 年。这些文章均为无对照组的前后观察性研究。平均年龄在 23.0-36.7 岁（跨性别男性）和 25.2-34.8 岁（跨性别女性）之间。干预措施多种多样，包括口服、透皮和注射激素制剂，随访时间为 4 个月至 5 年。大多数跨性别男性的研究并未显示 BP 变化，而接受 GHT 的跨性别女性的 SBP 则既有升高也有降低。这些研究存在显著的异质性和方法学局限性，仅有两项被确定为具有良好质量评分。
目前尚无足够的数据可以说明 GHT 对跨性别个体 BP 的影响。需要更好质量的研究来阐明外源性性激素是否调节跨性别者的 BP，以及这种潜在的改变是否暗示更差的心血管结局。
