Long-Term Hormone Therapy Reveals Cardiovascular Risks in Trans Men
Long-term hormone therapy changes body composition and raises cardiovascular risks, particularly in transgender men.
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Long-term sex hormone therapy in transgender individuals causes notable changes in body composition and cardiovascular risk factors, particularly among transgender men, according to new research from Karolinska Institutet. The findings, based on magnetic resonance imaging (MRI) and metabolic risk assessments over several years, were published in the Journal of Internal Medicine.
Significant body composition changes in transgender men
The study followed 17 transgender men undergoing testosterone therapy and 16 transgender women receiving oestrogen therapy for up to six years. In transgender men, muscle volume increased by an average of 21% within six years of testosterone treatment, but abdominal fat levels rose significantly, with a 70% increase. The study also noted higher liver fat and elevated levels of low-density lipoprotein (LDL) cholesterol – known as "bad cholesterol" – which may heighten the risk of cardiovascular disease.
Testosterone therapy: A form of hormone treatment used to induce masculinizing effects in transgender men, including increased muscle mass and body hair growth.
Oestrogen therapy: Hormone treatment for transgender women that promotes feminizing effects such as fat redistribution and breast development.
LDL cholesterol: Often called “bad cholesterol,” high levels of LDL contribute to plaque buildup in arteries and increase cardiovascular risk.
Divergent effects in transgender women
In contrast, transgender women on oestrogen therapy experienced less pronounced changes. Their muscle volume decreased by an average of 7% over five years, while muscle strength remained stable. Overall fat volume increased, though gains in abdominal fat were less significant compared to transgender men.
Study methodology and key findings
The research team conducted a series of MRI scans and blood tests to assess body composition, metabolic factors and vascular stiffness at three intervals: before hormone therapy, after one year and after five to six years of treatment.
Previous studies in this area have been relatively short-term, up to two years. Our results show that it is important to continue monitoring the long-term health effects of hormone therapy in transgender individuals to prevent cardiovascular disease and other health issues.”
Dr. Tommy Lundberg
Key findings include:
- Transgender men: Significant increases in muscle and fat volume, as well as heightened metabolic risk factors like liver fat and LDL cholesterol.
- Transgender women: Modest reductions in muscle volume and strength, accompanied by a general increase in fat volume, but with less abdominal fat accumulation.
Long-term health considerations
The researchers emphasize the importance of extended monitoring of hormone therapy's health effects. While the masculinizing and feminizing effects of hormone therapy align with patient expectations, some changes are more modest, highlighting the need to manage expectations and assess long-term health risks.
Future investigations will focus on understanding how hormone therapy influences skeletal muscle gene expression and the mechanisms driving changes in adipose tissue.
Reference: Lundberg TR, Tryfonos A, Eriksson LMJ, et al. Longitudinal changes in regional fat and muscle composition and cardiometabolic biomarkers over 5 years of hormone therapy in transgender individuals. J Intern Med. 2024;n/a(n/a). doi: 10.1111/joim.20039
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