‘Gender-affirming’ hormone therapy linked to stroke, heart attack, cancer, and more

by Jacob Fuller

Lauren Dempsey, MS in Biomedicine and Law, RN, FISM News 

A new study presented at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology highlighted the link between hormone replacement therapy as a part of gender affirmation therapy and an increased risk of serious cardiovascular events.

The team of researchers evaluated data on cardiovascular events in more than 21,000 people with gender dysphoria from a national database of hospital records and 1,675 individuals had used some form of hormone replacement therapy. The results found that hormone therapy was associated with higher rates of stroke, heart attack, and pulmonary embolism, as well as increased risk of breast cancer, substance use disorder, and hypothyroidism, although it was not associated with higher rates of death.

According to the research, individuals with gender dysphoria that had ever been prescribed hormone replacement therapy had almost seven times the risk of an ischemic stroke, almost six times the risk of heart attack, and almost five times the risk of pulmonary embolism compared to individuals who never received hormone replacement therapy.

The researchers acknowledge that the study did have some limitations. It could only account for the use of hormone replacement therapy. However, the duration of treatment, age of intervention, and type of hormone therapy used would help to better understand the associated cardiovascular risks, especially since the treatment option is becoming more widely used.

Testosterone and estrogen are common treatments for individuals with gender dysphoria who are undergoing gender-affirming therapy and are both associated with increased clotting. This type of therapy aims to treat individuals who believe they were born the wrong gender and includes medical, surgical, psychological, and behavioral therapy interventions as individuals transition.

Ibrahim Ahmed, MD is a third-year resident at Mercy Catholic Medical Center in Darby, Pennsylvania and the study’s lead author.

“It’s all about risks and benefits. Starting transitioning is a big part of a person’s life and helping them feel more themselves, but hormone replacement therapy also has a lot of side effects — it’s not a risk-free endeavor,” Ahmed explained.

According to a recent report, new data suggests that there are more than 1.6 million adults and youth that identify as transgender in the United States. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, gender dysphoria is prevalent in 0.005–0.014% of the population for biological males and 0.002–0.003% of biological females.

However, the number of those that identify as transgender, particularly children, is on the rise and so-called “gender-affirming treatmet” is becoming increasingly accessible for this vulnerable demographic.

At a 2020 conference, Dr. Jeremi Carswell, a pediatric endocrinologist and director of Boston Children’s Hospital Gender Management Service (GeMS), discussed how easily physicians prescribed puberty-blocking drugs to children while knowing that the medications came with lifelong risks, going on to say that physicians prescribe these medications “a lot like candy.”

Yet, even knowing the long-term risks, some activists claim — contrary to all scientific evidence — that the effects are completely reversible and if a child changes their mind, they can simply stop hormone replacement therapy, resume puberty, and get their body back. Puberty blockers have been found to cause low bone density; stunt height and increase the risk for osteoporosis and fractures, sterility, heart disease, cancer, and psychosis.  Data also shows that essentially none of its effects are “reversible.”

Some members of the medical community advocate for a more individual, patient-centered approach through exploratory psychotherapy for gender dysphoria. Such an approach allows therapists to provide recommendations and address multiple root cause factors for gender dysphoria. This approach also suggests that clinicians have difficult conversations with patients, making them aware that regardless of treatment, biological sex does not change.