McGinley Kirsty A, Lucas-Herald Angela K, Connelly Paul, Delles Christian
K A McGinley, School of Cardiovascular and Metabolic Health Sciences, University of Glasgow, Glasgow, UK.
A K Lucas-Herald, School of Cardiovascular and Metabolic Health Sciences, University of Glasgow, Glasgow, UK.
Endocr Connect. 2024 Nov 25;14(2). doi: 10.1530/EC-24-0222.
Gender-affirming hormone therapy (GAHT) is used in individuals with gender identity dysphoria to align an individual's secondary sexual characteristics with their affirmed gender. We conducted a systematic review of the literature to explore the mechanisms regarding the effects of GAHT on the vasculature.
A literature search using PUBMED, Embase, Scopus and Lilacs was performed using search terms for GAHT, cardiovascular disease (CVD) risk and transgender. Studies were screened by two independent reviewers. Comparison to a cohort of transgender individuals naïve or prior to GAHT or a cisgender population was required. Quality assessment was done using the relevant Critical Skills Appraisal Programme checklists.
Out of 2,564 potentially eligible studies, 69 studies met the inclusion criteria. Studies provided evidence of beneficial changes in CVD risk profile including reduced haemoglobin and pro-inflammatory markers, and atheroprotective changes in lipids in transgender women. In transgender men there was evidence of negative changes in CVD risk profile including atherogenic changes in lipids and increased haemoglobin, arterial stiffness, and pro-inflammatory markers.
There is a paucity of research across non-traditional measures of CVD risk which in combination with heterogeneous study design, loss of follow-up, low sample sizes and lack of diversity in age and ethnicity requires the results to be interpreted with caution. More evidence is required to elucidate the mechanisms behind the increased risk of CVD in the transgender population and determine if GAHT is a contributing factor.
性别肯定激素疗法（GAHT）用于患有性别认同障碍的个体，以使个体的第二性征与其确认的性别相符。我们对文献进行了系统综述，以探讨GAHT对血管系统影响的机制。
使用PUBMED、Embase、Scopus和Lilacs进行文献检索，检索词为GAHT、心血管疾病（CVD）风险和跨性别者。由两名独立的评审员对研究进行筛选。需要与未接受GAHT或接受GAHT之前的跨性别个体队列或顺性别群体进行比较。使用相关的关键技能评估计划清单进行质量评估。
在2564项可能符合条件的研究中，69项研究符合纳入标准。研究提供了CVD风险状况有益变化的证据，包括跨性别女性血红蛋白和促炎标志物降低，以及脂质的抗动脉粥样硬化变化。在跨性别男性中，有证据表明CVD风险状况出现负面变化，包括脂质的致动脉粥样硬化变化、血红蛋白增加、动脉僵硬和促炎标志物增加。
关于CVD风险的非传统测量方法的研究较少，再加上研究设计的异质性、随访缺失、样本量小以及年龄和种族缺乏多样性，需要谨慎解释研究结果。需要更多证据来阐明跨性别群体中CVD风险增加背后的机制，并确定GAHT是否是一个促成因素。
