Arterial Stiffness in Transgender Men Receiving Long-term Testosterone Therapy

Abstract

Context The effects of androgen therapy on arterial function in transgender men (TM) are not fully understood, particularly concerning long-term androgen treatment. Objective To evaluate arterial stiffness in TM receiving long-term gender-affirming hormone therapy by carotid-femoral pulse wave velocity (cf-PWV). Design A cross-sectional case-control study. Setting Gender Dysphoria Unit of the Division of Endocrinology, HC-FMUSP, Sao Paulo, Brazil. Patients Thirty-three TM receiving intramuscular testosterone (T) esters as regular treatment for an average time of 14 ± 8 years were compared to 111 healthy cisgender men and women controls matched for age and body mass index (BMI). Aortic stiffness was evaluated by cf-PWV measurements using the Complior® device post-testosterone therapy. Main outcome measures Aortic stiffness by carotid-femoral pulse wave velocity (cf-PWV) as a cardiovascular risk marker in transgender men and control group. Results The cf-PWV after long-term testosterone therapy was significantly higher in TM (7.4 ± 0.9 m/s; range: 5.8–8.9 m/s) than in cisgender men (6.6 ± 1.0 m/s; range: 3.8–9.0 m/s, p < 0.01) and cisgender women controls (6.9 ± 0.9 m/s; range: 4.8–9.1 m/s, p = 0.02). The cf-PWV was significantly and positively correlated with age. Analysis using blood pressure as a covariate showed a significant relationship between TM SBP and cf-PWV in relation to cisgender women but not to cisgender men. The age, the SBP and the diagnosis of hypertension were independently associated with cf-PWV in transgender men group. Conclusions The TM group on long-term treatment with testosterone had higher aging-related aortic stiffening than the control groups. These findings indicate that aortic stiffness might be accelerated in the TM group receiving the gender-affirming hormone treatment, and suggest a potential deleterious effect of testosterone on arterial function. Preventive measures in TM individuals receiving testosterone treatment, who are at higher risk for cardiovascular events, are highly recommended.