Do transgender people have a higher risk of heart problems?

What's on this page:

• What does transgender (trans) mean?
• What is gender-affirming hormone therapy?
• Is gender-affirming hormone therapy linked to heart problems?
• Do trans people have a higher risk of heart attack or stroke?
• Gary's journey: the fear of transitioning, triple bypass surgery and anxiety
• I am transgender: what can I do to reduce my risk?

What does transgender (trans) mean?

Being transgender (trans) means having a gender identity or expression that is different from the biological sex that was assigned to you at birth. It is estimated that there are up to 500,000 transgender people in the UK.

What is gender-affirming hormone therapy?

Gender-affirming hormone therapy is used by some trans people so that their body more closely matches their gender identity. It usually involves taking either testosterone or oestrogen.

Transgender people who have hormone therapy need to have their hormone levels monitored for the rest of their lives.

Is gender-affirming hormone therapy linked to heart problems?

There is some concern about a possible link between gender-affirming hormone therapy and the risk of heart and circulatory problems, including some evidence for a link with blood clots and dyslipidaemia (increased levels of fat in the blood). But there’s a lack of research in this area, and the research that does exist is often contradictory.

In 2019 Dr Paul Connelly, Clinical Lecturer at the University of Glasgow, led a BHF-funded review of previous research looking at the effects of hormone therapy. 

The researchers found some evidence for an increased risk of heart attacks and stroke in trans women, but not for trans men – though they did find higher blood pressure and cholesterol levels in trans men. 

But overall, they found that the quality of previous research was too poor to reach a conclusion. And some other studies have found an increased risk of heart attacks in trans men. Dr Connelly explains: “We’ve been using gender-affirming therapy for decades and yet the research in this area is only in its infancy.”

Many of the studies that do exist are small, or only had a short follow-up period, and some look only at younger trans people. Usually, the gold standard of testing the effects of a medication is a randomised controlled trial, where people are randomly chosen either to receive the treatment or an inactive placebo: but this isn’t possible or ethical when it comes to gender-affirming hormone treatment.

Some studies have suggested that gender-affirming hormone therapy is linked with higher blood pressure, both for trans men and trans women. But recent research papers, including a review of research on this topic published by Dr Connelly, have concluded that there’s not enough evidence to be sure.

Not only is the research often contradictory; many questions remain unanswered. Why would hormones have an effect on the cardiovascular system? And why is it that when oestrogen reduces the risk of heart disease in cisgender women, it potentially increases the risk for transgender women? 

Dr Connelly says: “We do not know for certain what the hormones do and why they could cause cardiovascular problems, but we know gender-affirming hormone treatment is lifesaving to many people, and I wouldn’t advise trans people stop this therapy. But we do need to research it better so we can reduce any risks.”

Do trans people have a higher risk of heart attack or stroke?

Yes. We know that trans people, whether or not they take hormones, are at higher risk of heart attacks and strokes. For example, a 2019 analysis using a large-scale survey of people in the USA found trans people had a higher reported history of heart attacks compared to cisgender people (people whose gender identity matches the biological sex they were born with), even after adjusting for other risk factors. Some of this is likely to be due to stigma and social factors. Dr Connelly explains that stigma and stress is common for trans people, and that this can also affect their cardiovascular health.

Dr Connelly says: “Transgender people can persistently face stigma (both internalised and from others), and experience discrimination and violence, which create psychological distress.” When you are consistently facing stress and distress, and experiencing poor mental health, it’s very hard to make positive lifestyle changes, and that can increase your risk of developing heart and circulatory diseases.

Dr Connelly adds: “Discrimination increases the risk of unhealthy behaviours like smoking.” He says that it’s important that health services such as stop smoking services and blood pressure checks are offered to transgender people in an inclusive way.

Gary's journey: the fear of transitioning, triple bypass surgery and anxiety

Gary's Journey "How I faced my fear of transitioning, a triple bypass surgery and anxiety." Read Gary's story

I am transgender: what can I do to reduce my heart risk

If you are transgender, you may be at higher risk of heart and circulatory problems. Here are some ways you can reduce your risk:

• Make sure your GP is regularly checking your hormone levels.
• Get a health check, including a blood pressure measurement: you might be recommended to have a health check regularly depending on the findings and what treatment you are on.
• If you have a family history of heart problems, ask at your GP surgery for a cholesterol test.
• Smoking can clog your arteries and could lead to a heart attack or stroke. If you smoke, ask your GP about services near you that could help, or get some tips for quitting.
• Monitor your alcohol intake, and take control of your drinking. Even cutting down can make a difference.
• Get help for issues that are causing you stress, such as discrimination, or your rights as a trans person.
• You can get support through Stonewall’s online information service or by calling 0800 050 2020. 
• Mermaids also offers support for gender-diverse young people and their families – you can phone them on 0808 801 0400.

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