Arterial Stiffness in Transgender Men Receiving Long-term Testosterone Therapy

Flávia Siqueira Cunha; Tania Aparecida Sartori Sanchez Bachega; Elaine Maria Frade Costa; Vinicius Nahime Brito; Leonardo Azevedo Alvares; Valéria Aparecida Costa-Hong; Renata Gomes Sanches Verardino; Maria Helena Palma Sircili; Berenice Bilharinho de Mendonça; Luiz Aparecido Bortolotto; Sorahia Domenice

doi:10.1210/jendso/bvad040

Arterial Stiffness in Transgender Men Receiving Long-term Testosterone Therapy

J Endocr Soc. 2023 Mar 17;7(5):bvad040. doi: 10.1210/jendso/bvad040. eCollection 2023 Mar 6.

Affiliations

¹ Disciplina de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 05403-900 São Paulo, SP, Brazil.
² Centro Universitário São Camilo, Curso de Medicina, Departamento de Endocrinologia, 04264-030 São Paulo, SP, Brazil.
³ Unidade de Hipertensão Arterial do Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 05403-900 São Paulo, SP, Brazil.

Abstract

Context: The effects of androgen therapy on arterial function in transgender men (TM) are not fully understood, particularly concerning long-term androgen treatment.

Objective: To evaluate arterial stiffness in TM receiving long-term gender-affirming hormone therapy by carotid-femoral pulse wave velocity (cf-PWV).

Methods: A cross-sectional case-control study at the Gender Dysphoria Unit of the Division of Endocrinology, HC-FMUSP, Sao Paulo, Brazil. Thirty-three TM receiving intramuscular testosterone esters as regular treatment for an average time of 14 ± 8 years were compared with 111 healthy cisgender men and women controls matched for age and body mass index. Aortic stiffness was evaluated by cf-PWV measurements using Complior device post-testosterone therapy. The main outcome measure was aortic stiffness by cf-PWV as a cardiovascular risk marker in TM and control group.

Results: The cf-PWV after long-term testosterone therapy was significantly higher in TM (7.4 ± 0.9 m/s; range 5.8-8.9 m/s) than in cisgender men (6.6 ± 1.0 m/s; range 3.8-9.0 m/s, P < .01) and cisgender women controls (6.9 ± .9 m/s; range 4.8-9.1 m/s, P = .02). The cf-PWV was significantly and positively correlated with age. Analysis using blood pressure as a covariate showed a significant relationship between TM systolic blood pressure (SBP) and cf-PWV in relation to cisgender women but not to cisgender men. Age, SBP, and diagnosis of hypertension were independently associated with cf-PWV in the TM group.

Conclusion: The TM group on long-term treatment with testosterone had higher aging-related aortic stiffening than the control groups. These findings indicate that aortic stiffness might be accelerated in the TM group receiving gender-affirming hormone treatment, and suggest a potential deleterious effect of testosterone on arterial function. Preventive measures in TM individuals receiving testosterone treatment, who are at higher risk for cardiovascular events, are highly recommended.

Keywords: arterial stiffness; carotid–femoral pulse wave velocity; female to male transsexual; testosterone; transgender man.