Transgender adults, gender-affirming hormone therapy and blood pressure: a systematic review

Connelly, P. J. , Clark, A., Touyz, R. M. and Delles, C. (2021) Transgender adults, gender-affirming hormone therapy and blood pressure: a systematic review. Journal of Hypertension, 39(2), pp. 223-230. (doi: 10.1097/HJH.0000000000002632) (PMID:32809982) (PMCID:PMC7810409)

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Objectives: Gender-affirming hormone therapy (GHT) is utilized by people who are transgender to align their secondary sex characteristics with their sex identity. Data relating to cardiovascular outcomes in this population are limited. We aimed to review the impact of GHT on the blood pressure (BP) of transgender individuals. Methods: We searched PubMed/MEDLINE, SCOPUS and Cochrane Library databases for articles published relating to the BP of transgender adults commencing GHT. Methodological quality was assessed via the ‘Quality Assessment Tool for Before–After (Pre–Post) Studies with No Control Group’. Results: Six hundred articles were screened, of which 14 studies were included in this systematic review encompassing 1309 individuals (∼50% transgender men and women) treated with GHT between 1989 and 2019. These articles were all pre–post observational studies without control groups. Mean ages ranged between 23.0–36.7 years (transgender men) and 25.2–34.8 years (transgender women). Interventions were diverse and included oral, transdermal and injectable hormonal preparations with 4 months to 5 years follow-up. Most studies in transgender men did not demonstrate a change in BP, whereas transgender women on GHT demonstrated an increase in SBP but not DBP. These studies were heterogenous with significant methodological limitations and only two were determined to have a good quality rating. Conclusion: There is currently insufficient data to advise the impact of GHT on BP in transgender individuals. Better quality research is essential to elucidate whether exogenous sex hormones modulate BP in transgender people and whether this putative alteration infers poorer cardiovascular outcomes.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Delles, Professor Christian and Connelly, Dr Paul and Touyz, Professor Rhian
Authors: Connelly, P. J., Clark, A., Touyz, R. M., and Delles, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of Hypertension
Publisher:Lippincott Williams & Wilkins
ISSN (Online):1473-5598
Published Online:18 August 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Journal of Hypertension 39(2): 223-230
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190814BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177Institute of Cardiovascular & Medical Sciences
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science