Expert opinion examines cardiovascular risk assessment during gender-affirming hormone therapy

An expert opinion in the European Journal of Preventive Cardiology summarizes cardiovascular evidence in transgender and gender diverse individuals, focusing on gender-affirming hormone therapy (GAHT), risk assessment, and clinical management. Cardiovascular prevention strategies are largely derived from cisgender populations and may not adequately capture GAHT exposure or population-specific determinants. The abstract reports no new study cohort or quantitative effect estimates.

Available evidence associates feminizing GAHT with increased venous thromboembolism risk. Masculinizing GAHT is associated with adverse lipid changes, erythrocytosis, and a potentially increased risk of major cardiovascular events. GAHT is also associated with changes in haemostasis, vascular function, and cardiac physiology. However, causal inference is limited by predominantly observational studies, relatively young populations, heterogeneous treatment regimens, short follow-up, and an absence of randomized evidence.

The authors emphasize that cardiovascular disparities should not be attributed to GAHT alone: smoking, obesity, physical inactivity, minority stress, socioeconomic disadvantage, and unequal healthcare access may contribute. Existing cardiovascular risk prediction tools have not been validated or calibrated in these populations. The opinion supports assessment integrating conventional and transgender-related risk factors with patients’ individual goals, alongside multidisciplinary prevention that preserves access to gender-affirming care. Long-term prospective studies and tailored risk prediction models remain research priorities.