Research shows trans women on hormone therapy at higher risk for cardiovascular diseases

heartTTckTHE GUERRILLA ANGEL REPORT — While the scientists who ran the study admit more research is needed, they disclosed that the cardiovascular disease mortality rate for trans women on hormonal therapy is higher than the general population. Trans men, however, are apparently not affected in the short-term.

The research also provided insight into other hormone treatment-related adverse effects.

The study was conducted by Katrien Wierckx, MD, and her team at University Hospital in Ghent, Belgium. The results were announced at the European Congress on Endocrinology earlier this month.

Wierckx: “Our main finding concerning hormonal therapy in transsexual persons is that hormonal therapy seems to be safe in transsexual men in the short and middle term (around 8 years) . . . [however] our results substantiate the few other studies published in the past 2 years, which observed that transsexual women have more cardiovascular diseases compared with the general population. . . .”


The comment stating that the findings substantiates earlier studies is troubling, if this holds up, it’ll become a factor for some. However, if the tradeoff is depression leading to suicide, then this concern would be of no consequence. I do think everyone needs to be informed though.

More [registration required]: Hormone Therapy Associated With CVD in Transsexual Women.



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Categories: Transgender, Transsexual, Trans

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31 replies

  1. Well, taking Premarine via pill form in large number of pills per day dosages have been known to affect the leg vein circulation and many of the patients on premarine seem to have an abundance of lower leg cramp problems, even noticing that their circulation seems to not be so good in the lower leg area, and there’s also the threat of a lung clot or a leg clot. I for one could vouch on the horrible lower leg cramps. I’d get at least 6 a week on the average. And I did know that my circulation seemed to suffer too. I’d imagine there is a high risk of heart failure being the result of clotting. But notice that if you take a poll of those taking some sort of female hormone on a large level basis, you’ll find that premarine seems to be the prescription choice to be covered on health insurance, and for the DUI hormone bunch, there is a lot less going to the doctor for health monitoring while taking hormones. Both these items would automatically create a surge on heart attack transgendered or transsexual victims. But also note that other means of taking hormones are more expensive per daily dosage. I would say that the insurance companies should be more flexible on what hormone types would be covered and what ones aren’t.

    • I don’t really understand why pills are preferred over patches in the US, because (although I don’t want to alarm anyone taking them) they’re clearly less safe. With patches the needed dose is much lower and is not going through the liver.

  2. I have two separate, un-paired genes that put me at higher risk for heart disease. When talking to my doctor about transitioning, once she saw that, she said she wouldn’t be comfortable putting me on the levels of estrogen needed to overcome the T in my body, even with anti-andros. She said she wouldn’t feel safe unless I had an orchiectomy, which brought me up really short. I don’t want any surgeries as part of my transition, and so it has affected my life in a big way, causing me to put the whole thing on hold while I sort it all out.

    • Sorting it out…….
      Time is a great tool. Given the freedom to make a life changing decision, take all the time that you want. Think about how far you want to go on a feminizing plan. Think long and hard. Don’t be afraid to engage in your mind’s challenging your feminization or transitioning plan. Life might be a bed of roses for a few transsexual girls, but for many it will be a road filled with rejection, criticism, and even mocking of you and your appearance. Divorcing can be very nasty. There may even be a few instances where you might even contemplate suicide (DON’T DO IT, not the answer). But serious thought is the good way to go. Don’t chuck caution to the wind, or do things because other people are doing it (BAD REASONING, please don’t go there if you think you might get disappointed). And yes, genetics has a lot to do with being genetically predispositioned towards coming down with parental or siblings getting the disease.

    • Get a second opinion. She might be wrong, or overly conservative, about the risk.

      • Also, note that it is possible to take anti-androgens with either no oestrogen or a very low dose of oestrogen, and this may help a great deal on its own, depending on precisely what you’re dysphoric about. (Anti-androgens alone will have a significant effect on body hair for example.) In the long term this does carry some risk of osteoporosis, but in the short term (a few years) it should be fine, and would give you time to consider the orchiectomy or other possibilities.

  3. Are they using ‘transsexual men’ in the correct way? My uncertainty about that is increased by its acute relevance to my current decision making.

    • I’ve heard that genetic woman have a 77 year life expectancy, where the average man has a 72 year life expectancy. The thought is that the testosterone hormone itself has a detrimental effect on the heart. I asked the doctor the question of if a transsexual male to female is on Estrogen hormones, does that actually prolong their life expectancy? He thought about it and said that there might be a connection for longer life. Vice-verse, I see lots of Female to males on testosterone who have gone bald shortly after their hormone therapy transition is complete. Only time will tell and lifetime health record surveys for a F2M’s life expectancy.

      • Testosterone affects all organs and parts of the body by improving the function. This is why the bodies of many older women start to increase the testoerone levels produced and the growth of body hair – moustaches, legs, etc. Meanwhile, male bodies are slowly, for most men, producing less testosterone thus the rapid aging of men past 65 – lost of upper body strength, stamina, etc.

        The average age of death in men has been increasing faster than for women in highly industrialised countries due to better health care, reduction of industrial accidents (also falling into or under farm equipment) due to greater safety regulations.

        Researchers have found it difficult to correlate though the relationship of age difference between men and women as it is very difficult to determine causal reality. Is it a relationship which appears to be related or is it just something which happens. Sort of like putting peanuts at the end of the bed to stop the elephants from waking you and not having seen elephants in your bedroom.

        Gender is not binary and actually consists of a whole range of factors. There is no actual fully male or fully female body. That kind of body would be super-gendered body. In my case, I have very low testosterone levels and normal male levels of estrogin/progestin.

        I’ve been on supplementation for years due to clinical depression and moodiness. Having been diagnosed with prostate cancer, the supplementation was stopped. As a result, I developed menopausal-like symptoms – headaches, crying spells, inability to concentrate among others. My doctor will not re-start the supplementation even though it still only brought me up to low normal.

        And I realised that my whole life has been more or less one of androgeny – not responding after puberty to the normal male urges. I have been married for 38 years and have had 2 relatively normal children. But due to my new interest in transgendering my marriage is being terminated although relatively amicably (for which I am thankful) despite my own feelings of rejection and guilt.

        Only starting to try to live my life inconspicuously changing makes me feel happy so I know that that may be a good thing for me. And I have done research into the physical effects particularly as I am older than “normal”ly when I person now decides to transgender.

        My concern now is to decide how this could be done for the best health. Is my lifelong stress being reduced healthier than changing hormone levels? That is the question as Hamlet so succinctly put it. And I have a lot more life-experience which includes multi-cultural experience, experience with jerks, xenophobes, bullies, air-heads and the insecure bastards (should that also be bitches?) who over-populate society.

        Just for your info – in Canada, females have an average age of 82 and males, 79. What will happen when they are equal?

    • Gwen, I’d try to get a hold of the entire report and talk it over with your health care provider. Good luck.

  4. I know the risks of hormonal therapy but this is part of our life’s path. Minimizing risks, I am for it. On the other hand, not being helped by doctors who are too afraid of the consequences will endanger the QUALITY of life of trans-women. Just because they don’t want us to die of heart attack? Well, if it is not that, it will be something else. And definitely, the choice should be OURS.
    I choose to live as best as possible, feeling alright with a hormonal regime that suits me in all knowledge that I may have a shorter life than others.Which is part of the natural reality of most people who were born genetically different.
    I have made peace with this and accepted that I might not go as far as other BUT with the realization that I have to live life to the fullest .Because no matter what, life, we all die from it!

    • Yes, Marsha, I agree with you. But I do know that many doctors, both endocrinologists and Internal medicine are refusing to take us as patients here in Ct. There too skittish of the possibility of lawsuits from transitioning patients who will have bad reactions from HRT. There also is a shortage of gynecologists who will treat you as postoperative patient with neo-vagina issues as well. Unfortunately, the doctors have the right to refuse a transitioning patient. What is one to do?

  5. hrt is not always safe for anyone receiving it. please get screened for genetic predispositon to cancer.

  6. I would like to know what the participants exercise habits, history of smoking, and dietary habits are in addition to family history of CVD. I would also be interested to know what type of hormone therapy is used (i.e. bio-identical or synthetic) as well as the delivery method (i.e. injectable vs. topical vs. oral).

    • Exactly! Lifestyle issues (diet, exercise) have a big part in our day to day health. After 50, estrogen patches are preferred over tablets, due to possible liver damage. This “study” needs a bit more work.

    • Another thing that bothers me is that they talk about the lipid profiles. I think it is important to note that just an increase in the raw values of HDL, LDL, Total Cholesterol, Triglycerides, apolipoprotein A-I (apoA-1) are not really good indicators for CVD by themselves. It is the ratios of them that are more predictive. HDL/Total Cholesterol ratio should be above 24%. Below 10% and there is a significant increase in CVD. Triglyceride/HDL ration should be below 2. Also important to check is both the fasting insulin levels, fasting glucose levels (should be below 79mg/dl), iron level (below 80ng/dl) as well as homocysteine level, which is one indicator for inflammation within the cardovascular system would be…

      • The above anonymous post was mine as well. I forgot to log in before hitting the post button.

        All but 1 diagnosis of type 2 diabetes was found before the start of hormonal therapy. In those cases, it was a pre-existing condition and unrelated to HRT. In the one case that was diagnosed after HRT, more information would be needed on the patients lifestyle, family history and specific lab results to comment on the cause. For instance, did the patient gain 20kg over the course of the study, does the family have a high incidence rate of type 2 diabetes that tends to manifest at a certain age range (i.e. mid 30s-40s),does the patient do any physical activity and what type, etc.

  7. All I know is that they recommended that I quit smoking for this reason. I still smoke a little, but cut it way down from where I was and a 22 year habit. I am too stressed to give it up! But anyway, these are the risks we take.

  8. The increased type II diabetes found in trans women can’t be due to exogenous hormones, because “all but one diagnosis in transsexual women were found before start of hormonal therapy” (

    Without knowing the delivery mechanism for oestrogen, which has a huge effect on required dose, I’m afraid the conclusions about trans women in most of the studies aren’t very useful. (Only one of the abstracts gives this information.) It was already known that pills have higher risks than patches, for example.

    The results of the study that did specify the treatment regimen in the abstract ( were that “In transwomen, anti-androgens and oestrogens induced a higher total and subcutaneous fat mass and lower lean mass, muscle mass and strength and a lower waist-hip ratio (all P≤0.001). Transmen gained lean body mass and muscle mass and strength and lost total body fat (all P<0.001) as well as subcutaneous fat after 1 year of testosterone (P=0.019). A decrease in HDL and increase in triglycerides was observed (P≤0.015)." This is surprising why? It seems like exactly the expected results of feminisation and masculinisation respectively.

    Also, the abstracts show significance levels but no effect sizes, and it isn't clear whether other risk factors, not related to hormone therapy, that might correlate with being trans were properly controlled for.

    • Interesting that you mentioned type 2 diabetes. I do have it. Earlier on in my life, I was found to be a borderline case. In other words I was found at times to be on the high limit number of 155. I was at the first also a DIY (do it yourself) person. After a year of self medicating at 1.25 mg 4 X a day premarine and 100 mg spironolactone 3 X a day, I decided to see an endo doc. He did all the blood tests and gave me a checkup. The end result was that he was happy with the dosages and advised me to continue under his direction and continued testing. But he did notice that I was exhibiting a higher level of sugar in my blood. He prescribed a pill regimen to hold the diabetes in check. But as time went on, the sugar levels went higher and higher until now, ten years after the HRT was started, I’m now on the higher limits of insulin injectables. Now I also gained one hell of a lot of weight during the process. MY metabolism changed and my food diet didn’t. I do know that if I loose weight, my diabetes will go down somewhat, and right now that’s my #1 game plan.

  9. It strikes me that it’s hard to separate out strictly physical causes (such as hrt) from other possible causes such as the increased stress many trans women experience during transition.

    • Transitioning stress ??? You can say that again. But in the end, it was still worth it.

    • A properly done study would be able able to account for that but like you said, not done easily. This may be one of the reasons the researchers have said more studies into this are needed. Thanks for the comment.

      • How would it be done? You can’t deny hormones to people to create a control group, so the only possibility would be a retrospective study of trans women who have transitioned without hormones. I would think it would be extremely difficult to find a large enough sample that way.

        • Actually, this kind of thing is done in medical research all the time I’m afraid. Partipicants know that some the group will be receiving placebos (or lower doses). However, I believe that researchers are able to identify and divide partipicants into different sub-groups based on their stress levels before they begin a study. But I’m getting over my head here and we ought to hear from post-grad level students or higher for more info.

  10. Hi everyone I new, so here is my story.
    i have been doing some research into Progesterone and found this site
    I’ve been post op for over 14 years now and have been on weekly estrogen injection as a safer alternative for HRT ( I have a family history of liver cancer) and 4 months ago my doctor has started me on Progesterone as a preventive for thinning bones and to for my breast health , I am a natural 38 D after 16 years of just being on estrogen for hormones and she thought it would be best if i were to take Progesterone for the next couple of years as she monitors me.
    I started transition when i was 36 years old and i am currently 52, Married to a Man and live my every day life with out other people knowing about my past. meaning i compleely blend into the world as my choosen gender role. this is my choice as I want people to know who I am rather look at me for being different or treated as a gay person which I feel I am not. I went as far to have my past ID secured by the courts.
    So now what concerns me is I know i will be on estrogen the rest of my life, but i have heard so much bad reports about Progesterone that it concerns me a little in taking it the next couple of years so far i have had no side effects. from taking both, and I don’t smoke and I’m not over weight. so I have to trust my doctor.
    this was a interesting artical to say the least .

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