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Incidence of hypertension in young transgender people after a 5-year follow-up: association with gender-affirming hormonal therapy

Hypertension Research volume 46, pages 219–225 (2023)Cite this article

A Comment to this article was published on 12 January 2023

Abstract

In order to assess the risk of hypertension development, we performed a retrospective analysis of the clinical records of consecutive transgender patients who began gender-affirming hormonal therapy in our Outpatient Gender Identity Clinic with <30 years of age and had a follow-up >5 years. 149 transgender women treated with estradiol and 153 transgender men treated with testosterone were included; 129 of the transgender women received also androgen blockers (54 spironolactone, 49 cyproterone acetate and 26 LHRH agonists). The annual incidence of hypertension in young transgender men (1.18%) seemed comparable to that of the general population. In young transgender women, it seemed higher (2.14%); we found that the choice of androgen blocker had a remarkable effect, with a highly significant increase in patients treated with cyproterone acetate (4.90%) vs. the rest (0.80%); the adjusted hazard-ratio was 0.227 (p = 0.001). Correlation, logistic regression and mediation analyses were performed for the associations of the available clinical variables with the increase in systolic blood pressure and the onset of hypertension, but besides the use of cyproterone acetate, only the ponderal gain was found significant (Spearman’s r: 0.361, p < 0.001); with a 36.7% mediation effect (31.2–42.3%). Cyproterone acetate has additional known risks, such as meningioma; although we cannot conclusively prove that it has a role in the development of hypertension, we conclude that the use of cyproterone acetate for this indication should be reconsidered.

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Acknowledgements

The authors gratefully acknowledge Mr. Satyajit Patel, Ph.D., for his suggestions and assistance with the statistical analysis. We have received no funding related to this study and report no conflicts of interest.

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Authors and Affiliations

  1. Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain

    Francisco Javier Martinez-Martin, Alba Hernandez-Lazaro, Ricardo Jose de Leon-Durango, Carlos Rios-Gomez, Borja Santana-Ojeda, Paula Maria Fernandez-Trujillo-Comenge & Claudia Arnas-Leon

  2. Endocrinology & Nutrition Dpt., Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Canary Islands, Spain

    Francisco Javier Martinez-Martin, Agnieszka Kuzior & Claudia Arnas-Leon

  3. Gerencia de Atención Primaria de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain

    Jennifer Maria Perez-Rivero, Esperanza Perdomo-Herrera, Alba Lucia Tocino-Hernandez, Maria del Sol Sanchez-Bacaicoa & Maria del Pino Perez-Garcia

  4. Emergency Medicine Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain

    Paula Gonzalez-Diaz

  5. Cardiology Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain

    Carmen Acosta-Calero

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  1. Francisco Javier Martinez-Martin
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Correspondence to Francisco Javier Martinez-Martin.

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Martinez-Martin, F.J., Kuzior, A., Hernandez-Lazaro, A. et al. Incidence of hypertension in young transgender people after a 5-year follow-up: association with gender-affirming hormonal therapy. Hypertens Res 46, 219–225 (2023). https://doi.org/10.1038/s41440-022-01067-z

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