Carl G. Streed Jr., MD; Omar Harfouch, MD, MPH; Francoise Marvel, MD; Roger S. Blumenthal, MD; Seth S. Martin, MD, MHS; Monica Mukherjee, MD, MPH
Disclosures: Dr. Streed has received funding support from an institutional National Research Service Award (T32HP10251), the Ryoichi Sasakawa Fellowship Fund, and the Brigham and Women's Hospital Division of General Internal Medicine and Primary Care. Dr. Martin has received research support from the David and June Trone Family Foundation, PJ Schafer Cardiovascular Research Fund, American Heart Association, Aetna Foundation, CASCADE FH, Google, and Apple; is a co-inventor on a pending patent filed by Johns Hopkins University for the novel method of low-density lipoprotein cholesterol estimation; and has served as a consultant to Quest Diagnostics, Sanofi/Regeneron, Amgen, and the Pew Research Center. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0577.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Requests for Single Reprints: Carl G. Streed Jr., MD, Division of General Internal Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Streed: Division of General Internal Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120.
Dr. Harfouch: Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.
Dr. Marvel: Department of Medicine, Johns Hopkins Bayview Medical Center, 1200 South Conkling Street, #208, Baltimore, MD 21224.
Dr. Blumenthal: Division of Cardiology, Johns Hopkins Hospital, Ciccarone Center, 600 North Wolfe Street, Halsted 560, Baltimore, MD 21287.
Dr. Martin: Division of Cardiology, Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie 591, Baltimore, MD 21287.
Dr. Mukherjee: Division of Cardiology, Johns Hopkins Bayview Medical Center, 301 Mason Lord Drive, Suite 2400, Baltimore, MD 21224.
Author Contributions: Conception and design: C.G. Streed, S.S. Martin, M. Mukherjee.
Analysis and interpretation of the data: C.G. Streed, O. Harfouch, R.S. Blumenthal, S.S. Martin, M. Mukherjee.
Drafting of the article: C.G. Streed, O. Harfouch, F. Marvel, M. Mukherjee.
Critical revision for important intellectual content: C.G. Streed, O. Harfouch, R.S. Blumenthal, S.S. Martin, M. Mukherjee.
Final approval of the article: C.G. Streed, O. Harfouch, F. Marvel, R.S. Blumenthal, S.S. Martin, M. Mukherjee.
Provision of study materials or patients: C.G. Streed, M. Mukherjee.
Statistical expertise: S.S. Martin, M. Mukherjee.
Administrative, technical, or logistic support: M. Mukherjee.
Collection and assembly of data: C.G. Streed, O. Harfouch, M. Mukherjee.
Recent reports estimate that 0.6% of adults in the United States, or approximately 1.4 million persons, identify as transgender. Despite gains in rights and media attention, the reality is that transgender persons experience health disparities, and a dearth of research and evidence-based guidelines remains regarding their specific health needs. The lack of research to characterize cardiovascular disease (CVD) and CVD risk factors in transgender populations receiving cross-sex hormone therapy (CSHT) limits appropriate primary and specialty care. As with hormone therapy in cisgender persons (that is, those whose sex assigned at birth aligns with their gender identity), existing research in transgender populations suggests that CVD risk factors are altered by CSHT. Currently, systemic hormone replacement for cisgender adults requires a nuanced discussion based on baseline risk factors and age of administration of exogenous hormones because of concern regarding an increased risk for myocardial infarction and stroke. For transgender adults, CSHT has been associated with the potential for worsening CVD risk factors (such as blood pressure elevation, insulin resistance, and lipid derangements), although these changes have not been associated with increases in morbidity or mortality in transgender men receiving CSHT. For transgender women, CSHT has known thromboembolic risk, and lower-dose transdermal estrogen formulations are preferred over high-dose oral formulations. In addition, many studies of transgender adults focus predominantly on younger persons, limiting the generalizability of CSHT in older transgender adults. The lack of randomized controlled trials comparing various routes and formulations of CSHT, as well as the paucity of prospective cohort studies, limits knowledge of any associations between CSHT and CVD.
Streed CG, Harfouch O, Marvel F, et al. Cardiovascular Disease Among Transgender Adults Receiving Hormone Therapy: A Narrative Review. Ann Intern Med. 2017;167:256–267. [Epub ahead of print 25 July 2017]. doi: https://doi.org/10.7326/M17-0577
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Published: Ann Intern Med. 2017;167(4):256-267.
Published at www.annals.org on 25 July 2017
Cardiology, Endocrine and Metabolism.
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