Project 458517

Transgender women (assigned male at birth with woman gender identity) have poor heart health. Yet, they are an understudied population in healthcare and research. To gain feminizing features, transgender women may use gender-affirming estrogen therapy. However, the effect of this medication on the heart and circulatory system is not currently known. Cisgender men (assigned male at birth with man gender identity) with higher levels of estrogen have more heart attacks, suggesting gender-affirming estrogen therapy may be dangerous for transgender women's heart health. However, the use of estrogen therapy improves both the physical and mental wellbeing of transgender women, highlighting the importance of understanding its effects and improving the safety of its use. Therefore, this research program will to explore the effects of gender-affirming estrogen therapy in transgender women, with a specific focus on how the way these hormones are taken (by mouth vs. creams, gels, patches) affect heart health. We will explore the relationship between levels of estrogen in blood circulation (resulting from gender-affirming estrogen therapy use) and rates of heart disease and death, compare rates of high blood pressure (a heart disease risk factor) and assess heart health directly, all with a specific focus on how the way in which these hormones are taken affect these relationships. As current hormone guidelines for transgender individuals are based on hormone ranges for cisgender women, the lack of precision-based therapies highlights the urgent need for guidelines that are both safe and specific to this community. This project will inform the use of gender-affirming estrogen therapy in transgender women, allowing them and their care providers to make informed decisions regarding its use and their overall heart health.