Cardiovascular health in transgender and gender diverse individuals: an expert opinion on gender-affirming hormone therapy, risk assessment and clinical management

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ID: 332108
2026
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Abstract
Transgender and gender diverse (TGD) individuals represent a growing population with specific cardiovascular health needs. Current cardiovascular prevention strategies are largely derived from cisgender populations and may not adequately account for the combined effects of gender-affirming hormone therapy (GAHT) and other determinants. This expert opinion summarizes current evidence regarding cardiovascular health in TGD individuals, focusing on the cardiovascular effects of GAHT, population-specific cardiovascular risk factors, practical approaches to cardiovascular risk assessment, and future research priorities. Available evidence indicates that GAHT is associated with changes in cardiometabolic risk factors, haemostasis, vascular function, and cardiac physiology. Feminizing GAHT is associated with an increased risk of venous thromboembolism, whereas masculinizing GAHT is associated with adverse lipid changes, erythrocytosis, and a potentially increased risk of major cardiovascular events. However, causal inference is limited by the predominance of observational studies, relatively young study populations, heterogeneous GAHT regimens, short follow-up, and the absence of randomized study evidence. Population-level cardiovascular disparities in TGD should not be attributed to GAHT alone and smoking, obesity, physical inactivity, minority stress, socioeconomic disadvantage, and unequal access to healthcare may independently or interactively influence cardiovascular risk. Current cardiovascular risk prediction tools have not been validated or calibrated in TGD populations and do not account for GAHT exposure or TGD-specific psychosocial and structural determinants. Cardiovascular risk assessment in TGD individuals should integrate conventional risk factors, transgender-related cardiovascular risk factors, and patient involvement regarding individual goals. A coordinated multidisciplinary approach may facilitate personalized cardiovascular prevention while supporting access to gender-affirming care. Future research should prioritize long-term prospective studies and development of risk prediction models tailored to TGD populations.
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Authors Marco Vecchiato, Lieve Mees van Zijverden, Jason O. van Heesewijk, Alberto Scala, Alessandro Biffi, Elena Campello, Paul J. Connelly, Andrea Garolla, Sean J. Iwamoto, Bethany Alice Jones, Oleksii Korzh, Donata Kurpas, Panteleimon Ε. Papakonstantinou, Stefano Palermi, Sanne A. E. Peters, Elio Venturini, Maria E. Marketou, Justine Defreyne, Dorte Glintborg
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Journal european journal of preventive cardiology
Year 2026
DOI
10.1093/eurjpc/zwag528
URL
https://doi.org/10.1093/eurjpc/zwag528
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