Transgender healthcare: metabolic outcomes and cardiovascular risk – published online 03/07/2024

Dorte Glintborg, Louise L. Christensen, Marianne S. Andersen

The number of transgender people seeking gender-affirming healthcare has increased during the last few years, and the expected lifelong changes in sex hormones during gender-affirming hormone therapy raises concern about adverse outcomes. In this issue, Glintborg et al (https://doi.org/10.1007/s00125-024-06212-6) summarise evidence on metabolic and cardiovascular outcomes during gender-affirming hormone treatment. CVD risk is increased in transgender people compared with cisgender control groups, but changes in known CVD risk markers during gender-affirming hormone treatment cannot explain this higher risk. The authors highlight, therefore, that separate risk markers such as age at initiation of gender-affirming hormone treatment, assigned sex at birth, minority stress and lifestyle factors should be considered. Shared decision making is a central part of transgender care and should focus on the balance between individual wishes for gender-affirming hormone treatment and CVD risk factors. The authors conclude that future studies should address personalised screening programmes for metabolic and CVD outcomes during gender-affirming hormone treatment with the aim of optimising transgender healthcare. The figures from this review are available as a downloadable slideset