While gender-affirming hormone therapy generally improves mood, some people may experience mood changes or worsening anxiety or depression. The current study is the largest to date examining the cardiovascular risks of gender-affirming therapy in this historically understudied population. Previous research on hormone-modulating medications has focused primarily on younger women using hormone-based contraception or on older women after hysterectomy or during menopause. In these populations, long-term hormone replacement therapy has been associated with an increased risk of breast cancer, stroke, and blood clots.
The researchers retrospectively examined the rates of cardiovascular events in more than 21,000 people with gender dysphoria from a national database of hospital records, of whom 1,675 had used hormone replacement therapy. However, it can be difficult to detect breast cancer in this tissue and there is a risk that the test result will be false positive. Starting the transition is an important part of a person's life and helps them feel better about themselves, but hormone replacement therapy also has many side effects and isn't without risks, said Dr. Ibrahim Ahmed, a third-year resident at Mercy Catholic Medical Center in Darby, Pennsylvania and lead author of the study.
Now that you've learned about the effects of masculinizing hormone therapy, as well as the risks and specific medication options, the next step will be to talk to your provider about what approach is best for you. Providers are encouraged to consult with their local laboratory to obtain reference ranges of hormone levels for male and female norms, and then apply the correct range when interpreting results based on current hormonal sex, rather than registered sex. Some patients may choose to undergo testosterone therapy for a period of time to develop these irreversible changes, and then stop taking it and return to their endogenous estrogen hormone environment. The goal of hormone therapy is to make you feel more comfortable with yourself, both in terms of your physical appearance and how you feel. Consider the effects of hormone therapy as if it were a second puberty, and puberty usually takes years to see all its effects. People receiving hormone replacement therapy also had higher rates of substance use disorder and hypothyroidism.
Whether you have undergone hormone therapy alone or in combination with surgery, the goal is to stop having gender dysphoria and to feel comfortable with your identity. After some time of adjusting to puberty blockers and confirming gender identity, gender-affirming hormone therapy may be an option. The HPV vaccine can greatly reduce the risk of cervical cancer, and you may want to discuss this with your healthcare provider. Both often have the added effect of suppressing the release of unwanted hormones from the testicles or ovaries.
If your ovaries have been removed, it's important that you continue to receive at least a low dose of hormones after surgery until you're at least 50 years old. The overall results revealed that hormone replacements were associated with higher rates of cardiac events, mostly related to the formation of dangerous blood clots, but were not associated with higher mortality rates. In this document, I will provide an overview of gender-affirming masculinizing hormone therapy, including the options, risks, and unknowns associated with the therapy with testosterone.
