Journal Article

The effect of transdermal gender-affirming hormone therapy on markers of inflammation and hemostasis

den Heijer, Martin, Schutte, Moya H., Snabel, Jessica M., Nota, Nienke M., Wiepjes, Chantal M., Kleemann, Robert, Thijs, Abel, T’Sjoen, Guy

2022

Overview

Cardiovascular risk is increased in transgender persons using gender-affirming hormone therapy. To gain insight into the mechanism by which sex hormones affect cardiovascular risk in transgender persons, we investigated the effect of hormone therapy on markers of inflammation and hemostasis. In this exploratory study, 48 trans women using estradiol patches plus cyproterone acetate (CPA) and 47 trans men using testosterone gel were included. They were between 18 and 50 years old and did not have a history of cardiovascular events. Measurements were performed before and after 3 and 12 months of hormone therapy. After 12 months, in trans women, systemic and endothelial inflammatory markers decreased (hs-CRP -66%, (95% CI -76; -53), VCAM-1-12%, (95% CI -16; -8)), while platelet activation markers increased (PF-4 +17%, (95% CI 4; 32), β-thromboglobulin +13%, (95% CI 2; 24)). The coagulation marker fibrinogen increased transiently, after 3 months (+15%, (95% CI 1; 32)). In trans men, hs-CRP increased (+71%, (95% CI 19; 145)); platelet activation and coagulation markers were not altered. In both trans women and trans men, leptin and adiponectin changed towards reference values of the experienced gender. Platelet activation and coagulation marker concentrations increased in trans women using transdermal estradiol plus CPA, but not in trans men using testosterone. Also, concentrations of inflammatory markers decreased in trans women, while hs-CRP increased in trans men. Our results indicate that hormone therapy may affect hemostasis in transgender persons, which could be an underlying mechanism explaining the increased cardiovascular risk in this population.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: 17β-Estradiol / Acetic acid / Adiponectin / Adolescent / Adult / Atherosclerosis / Biology and Life Sciences / Biomarkers / Blood & organ donations / Blood platelets / Blood pressure / Body fat / Body mass index / C-Reactive Protein / Cardiovascular diseases / Care and treatment / Coagulation / Complications and side effects / Cyproterone acetate / Cyproterone Acetate - therapeutic use / Cytokines / Endocrine therapy / Endocrinology / Estradiol / Estrogens / Female / Fibrinogen / Gender / Gender dysphoria / Gender identity / Gender-affirming care / Health aspects / Health risks / Heart attacks / Hemostasis / Hemostatics / Hormone therapy / Hormones / Humans / Inflammation / Inflammation - drug therapy / Insulin resistance / Leptin / Male / Markers / Medical research / Medicine and Health Sciences / Men / Metabolism / Middle Aged / Patient outcomes / People and Places / Platelets / Risk / Sex hormones / Testosterone / Therapy / Transgender Persons / Tumor necrosis factor-TNF / Vascular cell adhesion molecule 1 / Women / Young Adult