Article: Cardiovascular Risk In Transgender Patients

[Carolyn Marie]

https://www.thecardiologyadvisor.com/general-cardiology/exploring-cardiovascular-risk-in-transgender-patients/

 

This is important information for our community, even if I don't understand some of the details.

 

Carolyn Marie

[stveee]

Well it addressed the aspect of stress (anxiety/hypertension) associated with being a vulnerable minority population, which I was hoping would be noted. Which for the most part would be alienaton. Anxiety and stress by itself is a killer and leads to all sorts of health problems.

 

[Guest]

This meandering article raises some questions. As a study population, we are a small group. In the samples that were studied, the key findings are that there may be an increased risk of cardiovascular events. This is not surprising for those who were assigned-female-at-birth. Natal women often have smaller cardiac muscle mass as well as smaller blood vessel diameter. This is not surprising, and has been known for over 25 years. With adding testosterone to the mix, there can be an increase in circulating lipids, and the risks of heart disease go up. Throw in any cofactors such as obesity, cigarette smoking, and hypertension, and you have a recipe for increased risk. Strangely enough, transgender men did not have as much risk of venous thromboembolism. 

 

This study has its' limitations. It is no surprise that if they were surveying a study population of transgender women and men that the majority of us were on hormone replacement therapy, short of an ovarian or testicular transplant, we are on long-term hormone treatments. What is truly limiting is that there is no way to know what other confounding pre-existing risk factors were already present in the study population. Many of us who are transitioning have already been through some dark times where we may have not paid any attention to our overall health. Some of us picked up bad habits in our coping with our gender dysphoria. 

 

I would worry if there was a long-term longitudinal study looking at cardiovascular health in the transgender male and female populations over a 20 year period or so. Otherwise, studies like this are like playing whack-a-mole trying to match up the actual cause and effect relationships. By the time we transition, our cardiovascular health or lack thereof, may have already started on the wrong trajectory.

 

As far as some points offered, estrogen has a well-known risk of thromboembolic disease. Basically, you are more likely to get blood clots from hormone replacement therapy. Oral estrogens have the highest risk, followed by patches, and then injections. If one is obese, has hypertension, diabetes, and smokes, the risks go up exponentially. Even if you were not transitioning, those risk factors are huge for anybody. One of the interesting things is that they did not see as much risk of heart disease in those assigned-male-at-birth. Transgender women did not have the same increase in heart disease risk as transgender men, but have an increase of venous thromboembolism.

 

One of the points that the article talks about is whether opportunities for exercise are limited by fear of using public gyms. Another point raised is the issue of minority stress. These points make sense.

 

The best take aways:

Keep yourself in great shape. Find a way to do this safely and exercise if you can.

Lose weight.

Get assistance to stop smoking (it is hard). Smoking and hormones do not bode well for blood clots, venous or arterial.

Reduce your intake of high fat/high cholesterol foods. 

Reduce your salt intake.

If you are on spironolactone, keep hydrated, and monitor your intake and output.

Monitor your blood pressure if you are on spironolactone.

Do not take any potassium supplements if you are on spironolactone as this can increase your potassium level to lethal levels.

Make sure your electrolytes, especially potassium and magnesium, by your primary care provider.

If you have dizziness or palpitations, notify your provider ASAP.

Work on a stress reduction strategy, or consider counseling if you are not already getting counseling.

Watch your intake of non-steroidal anti-inflammatory medications such as ibuprofen as it can increase your fluid retention and increase your blood pressure.

Make sure you see a qualified healthcare provider who actually takes the time to listen and help you manage your health.

 

In other words, look at your health and take ownership of it if you are going to tax your system with transition. 

[Carolyn Marie]

2 hours ago, Katie23 said:

 

 

Make sure you see a qualified healthcare provider who actually takes the time to listen and help you manage your health.

 

In other words, look at your health and take ownership of it if you are going to tax your system with transition. 

 

@Katie23you raise excellent points, especially the last.  Unfortunately it is not easy to find a good doctor, and when you do, hang on to them.  A good PCP can save your life.

 

Carolyn Marie

[Lydia_R]

I certainly worry some about this.  I'm 51 and have varicose and spider veins starting to pop up.  I decreased my salt intake a few years ago and that has had a positive effect on my blood pressure.  I'm experimenting with compression socks now.  I'm not sure there is anything more I can do except to worry 😀