Turino Miranda Keila, Schwende Brittany K, Duval Alicia, Streed Carl G, Delage Shannon I, Chokly Kit, Hodgins Vegas, Usselman Charlotte W
Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.
Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada.
Auton Neurosci. 2025 Aug;260:103283. doi: 10.1016/j.autneu.2025.103283. Epub 2025 Apr 28.
Blood pressure is a key indicator of cardiovascular health with chronically high levels increasing the risk of cardiovascular diseases (CVD) such as heart attack and stroke. Emerging evidence shows that transgender, gender-diverse, and non-binary (TGD) adults tend to have higher blood pressure than age-matched cisgender adults, corresponding to an increased CVD risk in this population. Yet, the mechanisms underlying elevated blood pressure in TGD adults remain unclear, posing challenges to TGD-affirming healthcare. Given the autonomic nervous system's role in CVD - wherein reduced parasympathetic and heightened sympathetic activity are key risk factors for CVD - this review explores the question: "Is cardiovascular disease risk in TGD adults associated with autonomic imbalance?" Limited research exists on autonomic balance within TGD populations. Accordingly, this review considers how TGD-specific factors, such as minority stress, lifestyle behaviors, sex and gender, and hormones (i.e., testosterone, estrogen, progesterone), may impact autonomic balance. Finally, this review aims to underscore the critical need for interdisciplinary research to elucidate these mechanisms and advance TGD-inclusive healthcare in the domains of autonomic control of blood pressure and overall cardiovascular health.
血压是心血管健康的关键指标，长期高血压会增加患心血管疾病（CVD）的风险，如心脏病发作和中风。新出现的证据表明，跨性别、性别多样化和非二元性别的（TGD）成年人往往比年龄匹配的顺性别成年人血压更高，这意味着该人群患心血管疾病的风险增加。然而，TGD成年人血压升高的潜在机制仍不清楚，这给支持TGD的医疗保健带来了挑战。鉴于自主神经系统在心血管疾病中的作用——其中副交感神经活动减少和交感神经活动增强是心血管疾病的关键风险因素——本综述探讨了以下问题：“TGD成年人患心血管疾病的风险是否与自主神经失衡有关？”关于TGD人群自主神经平衡的研究有限。因此，本综述考虑了TGD特有的因素，如少数群体压力、生活方式行为、性别和激素（即睾酮、雌激素、孕酮），可能如何影响自主神经平衡。最后，本综述旨在强调跨学科研究的迫切需求，以阐明这些机制，并在血压自主控制和整体心血管健康领域推进包含TGD人群的医疗保健。
