Buhl Laust Frisenberg, Andersen Marianne S, Frystyk Jan, Diederichsen Axel, Hasific Selma, Hjortebjerg Rikke, Dahl Jordi Sanchez, Noori Manijeh, Hansen Kirstine Nørregaard, Jørgensen Gitte Maria, Palm Camilla Viola, Kristensen Tine Taulbjerg, Glintborg Dorte, Christensen Louise Lehmann
Department of Endocrinology, Odense University Hospital, Odense, Denmark.
Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Andrology. 2025 Jan 13. doi: 10.1111/andr.13832.
Myocardial dysfunction and the presence of calcified and non-calcified coronary plaques are predictors of cardiovascular disease. Masculinizing gender-affirming hormone therapy may increase cardiovascular risk, highlighting the need for prospective studies to evaluate cardiovascular outcomes during gender-affirming hormone therapy.
To evaluate changes in cardiac morphology, systolic and diastolic function, and development of coronary plaques after masculinizing gender-affirming hormone therapy.
Prospective study including 47 transmasculine persons (gender-affirming hormone therapy-naïve, TransM_TN, n = 15 and gender-affirming hormone therapy-ongoing, TransM_TO, n = 32). Included persons were evaluated at study inclusion and after one year of masculinizing gender-affirming hormone therapy. At baseline, the median age of TransM_TN was 22 years (interquartile range 19-28 years) and TransM_TO 26 years (interquartile range 24-37 years) with a median gender-affirming hormone therapy duration of 4 years (interquartile range 2-5 years). Cardiac morphology including left ventricular wall thickness, volume, and mass, as well as left ventricular systolic and diastolic function was evaluated using echocardiography. Coronary artery calcifications and non-calcified coronary plaque were assessed using coronary computed tomography angiography. Paired and unpaired statistical analyses were performed within and between TransM_TN and TransM_TO groups.
In TransM_TN, diastolic function decreased during follow-up with decreased septal and lateral left ventricular relaxation (14-11 cm/s, p = 0.04 and 18-15 cm/s, p = 0.02, respectively). No significant changes were observed in cardiac morphology, systolic function, or formation of coronary artery calcifications and non-calcified coronary plaque in TransM_TN or TransM_TO groups. At baseline, left ventricular end-diastolic internal diameter was significantly higher in TransM_TO compared to TransM_TN, 4.6 cm (interquartile range 4.3-5.0 cm) versus 4.4 cm (interquartile range 4.2-4.6 cm), p < 0.05. Other baseline cardiac outcomes were comparable between TransM_TN and TransM_TO.
Diastolic function declined after the initiation of masculinizing gender-affirming hormone therapy and individuals on long-term masculinizing gender-affirming hormone therapy had larger left ventricular dimensions compared to individuals before gender-affirming hormone therapy initiation. Cardiac morphology, systolic function, and coronary plaque formation remained stable during masculinizing gender-affirming hormone therapy.
心肌功能障碍以及钙化和非钙化冠状动脉斑块的存在是心血管疾病的预测指标。男性化性别肯定激素疗法可能会增加心血管风险，这凸显了进行前瞻性研究以评估性别肯定激素疗法期间心血管结局的必要性。
评估男性化性别肯定激素疗法后心脏形态、收缩和舒张功能的变化以及冠状动脉斑块的发展情况。
前瞻性研究纳入了47名跨性别男性（未接受过性别肯定激素疗法的，TransM_TN组，n = 15；正在接受性别肯定激素疗法的，TransM_TO组，n = 32）。纳入研究的对象在入组时以及接受一年男性化性别肯定激素疗法后接受评估。基线时，TransM_TN组的中位年龄为22岁（四分位间距19 - 28岁），TransM_TO组为26岁（四分位间距24 - 37岁），性别肯定激素疗法的中位疗程为4年（四分位间距2 - 5年）。使用超声心动图评估心脏形态，包括左心室壁厚度、容积和质量，以及左心室的收缩和舒张功能。使用冠状动脉计算机断层扫描血管造影评估冠状动脉钙化和非钙化冠状动脉斑块。在TransM_TN组和TransM_TO组内部及之间进行配对和非配对统计分析。
在TransM_TN组中，随访期间舒张功能下降，室间隔和左心室侧壁舒张速度减慢（分别从14 cm/s降至11 cm/s，p = 0.04；从18 cm/s降至15 cm/s，p = 0.02）。在TransM_TN组或TransM_TO组中，未观察到心脏形态、收缩功能或冠状动脉钙化及非钙化冠状动脉斑块形成有显著变化。基线时，TransM_TO组的左心室舒张末期内径显著高于TransM_TN组，分别为4.6 cm（四分位间距4.3 - 5.0 cm）和4.4 cm（四分位间距4.2 - 4.6 cm），p < 0.05。TransM_TN组和TransM_TO组的其他基线心脏指标具有可比性。
开始男性化性别肯定激素疗法后舒张功能下降，与未开始性别肯定激素疗法的个体相比，长期接受男性化性别肯定激素疗法的个体左心室尺寸更大。在男性化性别肯定激素疗法期间，心脏形态、收缩功能和冠状动脉斑块形成保持稳定。
