A case report of myocardial infarction in a young transgender man with testosterone therapy? raising awareness on healthcare issues in the transgender community and a call for further research

Connelly, P. , Osmanska, J., Lee, M. M.Y. , Delles, C. , McEntegart, M. B. and Byrne, J. (2023) A case report of myocardial infarction in a young transgender man with testosterone therapy? raising awareness on healthcare issues in the transgender community and a call for further research. European Heart Journal: Case Reports, 7(12), ytad562. (doi: 10.1093/ehjcr/ytad562) (PMID:38093823) (PMCID:PMC10716680)

Abstract

Background People who are transgender may utilize masculinizing or feminizing gender-affirming hormonal therapy. Testosterone and oestrogen receptors are expressed throughout the cardiovascular system, yet the effects of these therapies on cardiovascular risk and outcomes are largely unknown. We report the case of a young transgender man with no discernible cardiovascular risk factors presenting with an acute coronary syndrome. Case summary A 31-year-old transgender man utilizing intramuscular testosterone masculinizing gender-affirming hormonal therapy presented with central chest pain radiating to the left arm. He had no past medical history of hypertension, dyslipidaemia, diabetes, or smoking. Electrocardiography demonstrated infero-septal ST depression, and high-sensitivity troponin-I was elevated and increased to 19 686 ng/L. He was diagnosed with a non–ST-segment elevation myocardial infarction. Inpatient coronary angiography confirmed a critical focal lesion in the mid right coronary artery, which was managed with two drug-eluting stents. Medical management (i.e. aspirin, ticagrelor, atorvastatin, ramipril, and bisoprolol) and surveillance of residual plaque disease evident in the long tubular left main stem, proximal left anterior descending, and proximal circumflex vessels was undertaken. The masculinizing gender-affirming hormonal therapy was continued. Discussion Despite a greater awareness of the potential risk of increased cardiovascular disease in transgender people, the fundamental lack of data regarding cardiovascular outcomes in transgender people may be contributing to healthcare inequalities in this population. We must implement better training, awareness, and research into transgender cardiovascular health to facilitate equitable and evidence-based outcomes.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Byrne, Dr John and Lee, Matthew and McEntegart, Dr Margaret and Delles, Professor Christian and Osmanska, Dr Joanna and Connelly, Dr Paul
• Authors: Connelly, P., Osmanska, J., Lee, M. M.Y., Delles, C., McEntegart, M. B., and Byrne, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: European Heart Journal: Case Reports
• Publisher: Oxford University Press on behalf of the European Society of Cardiology.
• ISSN: 2514-2119
• ISSN (Online): 2514-2119
• Published Online: 06 December 2023
• Copyright Holders: Copyright: © The Author(s) 2023
• First Published: First published in European Heart Journal: Case Reports 7(12):ytad562
• Publisher Policy: Reproduced under a Creative Commons licence