Transgender Women with Suppressed Testosterone Display Lower Burden of Coronary Disease Than Matched Cisgender Men

Jordan E. Lake, Han Feng, Ana N. Hyatt, Hongyu Miao, Paula Debroy, Nicholas Funderburg, Kate Ailstock, Adrian Dobs, Sabina Haberlen, Jared W. Magnani, Joseph B. Margolick, Kate McGowan, Frank J. Palella, Mallory D. Witt, Shalender Bhasin, Matthew J. Budoff, Wendy S. Post, Todd T. Brown

Research output: Contribution to journalArticlepeer-review

Abstract

Context: Cardiovascular disease (CVD) in transgender women (TW) may be affected by gender-affirming hormone therapy (GAHT) and HIV, but few data compare TW on contemporary GAHT to well-matched controls. Objective: We compared CVD burden and biomarker profiles between TW and matched cisgender men (CM). Methods: Adult TW on GAHT (n = 29) were recruited for a cross-sectional study (2018-2020). CM (n = 48) from the former Multicenter AIDS Cohort Study were matched 2:1 to TW on HIV serostatus, age ±5 years, race/ethnicity, BMI category and antiretroviral therapy (ART) type. Cardiac parameters were measured by CT and coronary atherosclerosis by coronary CT angiography; sex hormone and biomarker concentrations were measured centrally from stored samples. Results: Overall, median age was 53 years and BMI 29 kg/m2; 69% were non-white. All participants with HIV (71%) had viral suppression on ART. Only 31% of TW had testosterone suppression (<50 ng/dL, TW-S). Traditional CVD risk factors were similar between groups, except that TW-S had higher BMI than TW with non-suppressed testosterone (TW-T). TW-S had no evidence of non-calcified coronary plaque or advanced coronary stenosis, whereas TW-T and CM had similar burden. TW had lower prevalence of any coronary plaque, calcified plaque and mixed plaque than CM, regardless of testosterone concentrations and HIV serostatus. Estradiol but not testosterone concentrations moderately and negatively correlated with the presence of coronary plaque and stenosis. Small sample size limited statistical power. Conclusion: Older TW with suppressed total testosterone on GAHT had no CT evidence of non-calcified coronary plaque or advanced coronary stenosis. Longitudinal studies to understand relationships between GAHT and CVD risk in TW are needed.

Original languageEnglish (US)
Article numberbvae120
JournalJournal of the Endocrine Society
Volume8
Issue number8
DOIs
StatePublished - Aug 1 2024

Keywords

  • HIV
  • coronary disease
  • gender-affirming hormone therapy
  • transgender women

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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