Gender-Affirming Hormone Therapy and Cardiovascular Risk in Transgender People: Scoping Review with ☸️SAIMSARA

Name: SAIMSARA Evidence Object vascular::GENDER_AFFIRMING_HORMONE_CARDIOVASCULAR_RISK_SS
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara9d970a85

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Gender-Affirming Hormone Therapy and Cardiovascular Risk in Transgender People: Scoping Review with ☸️SAIMSARA

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara9d970a85

Editorial note

• Last update: 2026-06-03 12:11:17

What is this paper about

Gender-affirming hormone therapy is not a single cardiovascular exposure: testosterone, estrogen route, anti-androgen choice, age, comorbidity, and monitoring all shift the risk picture. This full read maps 319 original studies, 114 key references, and more than 15.7 million observations to clarify where GAHT appears safer, where vascular risk signals emerge, and what clinicians should watch before relying on generic sex-based risk calculators.

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Abstract: To comprehensively map and synthesize the existing evidence on the association between gender-affirming hormone therapy and cardiovascular risk, encompassing clinical outcomes, surrogate markers, and mechanistic pathways, across human cohort, cross-sectional, case, and experimental studies. The review uses 114 references and builds its evidence map from 319 original studies with 15735475 total participants/sample observations (topic-deduplicated ΣN). This scoping review indicates that cardiovascular risk under GAHT is strongly hormone-direction dependent, with masculinizing testosterone consistently associated with adverse lipid shifts, erythrocytosis, arterial stiffness, and endothelial dysfunction, while feminizing regimens show mixed signals dominated by route- and antiandrogen-specific VTE and blood pressure effects. Mechanistic convergence on immune-mediated endothelial dysfunction, including CD4+ T-cell and IL-17 pathways, suggests a biologically plausible substrate linking testosterone exposure to vascular pathology. Clinically, the evidence supports a role for individualized regimen selection—favoring non-oral estrogen and careful antiandrogen choice—alongside surveillance of subclinical vascular markers rather than reliance on sex-based risk calculators alone. However, attribution to GAHT itself remains uncertain given baseline comorbidity burden and conflicting cohort findings. Long-term prospective studies with hard cardiovascular endpoints and TGD-specific risk prediction tools are the central priority.
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Keywords: Gender-affirming hormone therapy; Cardiovascular risk; Transgender health; Estradiol; Testosterone therapy; Atherosclerosis; Endothelial dysfunction; Venous thromboembolism; Myocardial infarction; Inflammation

Review Stats

Final search date and database lock: 2026-05-24 17:49:02 CEST
Plan: Pro (expanded craft tokens; source: Semantic Scholar)
Source: Semantic Scholar
Total Abstracts/Papers: 1335
Downloaded Abstracts/Papers: 1000
Included original and non-original Abstracts/Papers (all): 649
Included original Abstracts/Papers (Vote counting by direction of effect): 319
Reference Index (links used in paper): 114
Total participants/sample observations (topic deduplicated ΣN): 15735475

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Reference Index (114)

[1] Gender-affirming hormone therapy and cardiovascular health in transgender adults — https://doi.org/10.1080/13697137.2024.2310518
[2] Transgender persons receiving gender-affirming hormone therapy: risk of acute cardiovascular events in a Dutch cohort study. — https://doi.org/10.1093/eurheartj/ehaf837
[3] Abstract We0073: Microvascular Dysfunction in Transgender Men on Testosterone Gender-Affirming Hormone Therapy: Implications for Cardiovascular Risk — https://doi.org/10.1161/atv.45.suppl_1.we0073
[4] Gender-affirming hormone therapy: effects on cardiovascular risk and vascular function — https://doi.org/10.1530/ec-24-0222
[5] Assessing the Influence of Long-Term Gender-Affirming Hormone Therapy on Cardiovascular Risk in Transgender Men through Carotid Intima–Media Thickness — https://doi.org/10.3390/jcm13196001
[6] Effects of gender-affirming hormone therapy on cardiovascular risk factors focusing on glucose metabolism in an Austrian transgender cohort. — https://doi.org/10.1080/26895269.2022.2123425
[7] Effects of sex steroids on cardiovascular risk profile in transgender men under gender affirming hormone therapy. — https://doi.org/10.1016/j.endinu.2018.11.004
[8] Gender affirming hormone therapy in the male rat is associated with differential effects on cardiovascular risk factors — https://doi.org/10.1152/physiol.2023.38.s1.5731234

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