Gender-affirming estrogen therapy route of administration and cardiovascular risk: a systematic review and narrative synthesis.
Published Sep 2, 2022 · Keila Turino Miranda, C. Kalenga, N. Saad
American journal of physiology. Heart and circulatory physiology
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Abstract
AbstractBackground:Transgender women (individuals assigned male sex at birth who identify as women), non-binary and gender-diverse individuals receiving gender-affirming estrogen therapy (GAET) are at increased cardiovascular risk. Non-oral (i.e. patch, injectable) compared to oral estrogen exposure in cisgender women (individuals assigned female sex at birth who identify as women) may be associated with lower cardiovascular risk, though whether this applies to transgender women and/or gender-diverse individuals is unknown. We sought to determine the association between the route of estrogen exposure (non-oral compared to oral) and cardiovascular risk in transgender women. METHODS Bibliographic databases (MEDLINE, Embase, PsycINFO), and supporting relevant literature, were searched from inception to January 2022. Randomized controlled trials and observational studies that reported cardiovascular outcomes such all-cause and cardiovascular mortality, adverse cardiovascular events, and cardiovascular risk factors in individuals using non-oral compared to oral gender-affirming estrogen therapy were included. RESULTS The search strategy identified 3,113 studies, 5 of which met inclusion criteria (3 prospective cohort studies, 1 retrospective cohort study, and 1 cross-sectional study; n=259 participants, range of duration of exposure of 2 to 60 months). One out of 5 studies reported on all-cause and cardiovascular mortality or adverse cardiovascular events. All five studies reported lipid levels (LDL, HDL, TG and TC), while only two studies reported SBP and DBP. CONCLUSION Limited studies have examined the effect of the route of GAET on all-cause cardiovascular mortality and morbidity and adverse cardiovascular events. Additionally, there is significant heterogeneity in studies examining the cardiovascular effects of GAET.