Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer- Hospital Clinic, Barcelona, Spain.
Endocrinology Department, Hospital Clinic, Barcelona, Spain.
Front Endocrinol (Lausanne). 2021 Sep 30;12:718200. doi: 10.3389/fendo.2021.718200. eCollection 2021.
Transgender men and women represent about 0.6 -1.1%% of the general population. Gender affirming hormone therapy (GAHT) helps ameliorate gender dysphoria and promote well-being. However, these treatments' cardiovascular (CV) effects are difficult to evaluate due to the limited number of extensive longitudinal studies focused on CV outcomes in this population. Furthermore, these studies are mainly observational and difficult to interpret due to a variety of hormone regimens and observation periods, together with possible bias by confounding factors (comorbidities, estrogen types, smoking, alcohol abuse, HIV infection). In addition, the introduction of GAHT at increasingly earlier ages, even before the full development of the secondary sexual characteristics, could lead to long-term changes in CV risk compared to current data. This review examines the impact of GAHT in the transgender population on CV outcomes and surrogate markers of CV health. Furthermore, we review available data on changes in DNA methylation or RNA transcription induced by GAHT that may translate into changes in metabolic parameters that could increase CV risk.
跨性别男性和女性约占总人口的 0.6-1.1%。性别肯定激素治疗（GAHT）有助于缓解性别焦虑症并促进幸福感。然而，由于针对该人群的 CV 结局的广泛纵向研究数量有限，这些治疗的心血管（CV）影响难以评估。此外，由于各种激素方案和观察期，以及混杂因素（合并症、雌激素类型、吸烟、酗酒、HIV 感染）可能导致的偏倚，这些研究主要是观察性的，难以解释。此外，GAHT 的引入年龄越来越早，甚至在第二性征完全发育之前，与目前的数据相比，可能导致 CV 风险的长期变化。这篇综述检查了 GAHT 在跨性别人群中对 CV 结局和 CV 健康的替代标志物的影响。此外，我们回顾了 GAHT 引起的 DNA 甲基化或 RNA 转录变化的可用数据，这些变化可能转化为代谢参数的变化，从而增加 CV 风险。
