Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Hypertension in transgender individuals

Journal of Human Hypertension (2022)Cite this article

Subjects

Abstract

Although there has been a dramatic increase in visibility and recognition of transgender and gender-diverse populations, remarkably little has been published on prevalence rates of hypertension within these populations. In addition to summarizing the limited data on prevalence rates, this review compares the prevalence rates with those of cisgender populations and explores whether gender-affirming hormone therapy affects blood pressure and hypertension rates. The studies show that hypertension affects a significant proportion of transgender and gender-diverse people and support the practice of routinely monitoring blood pressure in transgender and gender-diverse people, especially after the initiation of gender-affirming hormone therapy. The two largest studies both found that estrogen plus an antiandrogen was associated with a decrease in systolic blood pressure and that testosterone was associated with an increase in systolic blood pressure.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  1. Banks K, Kyinn M, Leemaqz SY, Sarkodie E, Goldstein D, Irwig MS. Blood pressure effects of gender-affirming hormone therapy in transgender and gender-diverse adults. Hypertension. 2021;77:2066–74.

    Article  CAS  Google Scholar 

  2. Nokoff NJ, Scarbro S, Juarez-Colunga E, Moreau KL, Kempe A. Health and cardiometabolic disease in transgender adults in the United States: behavioral risk factor surveillance system 2015. J Endocr Soc. 2018;2:349–60.

    Article  Google Scholar 

  3. Balcerek MI, Nolan BJ, Brownhill A, Wong P, Locke P, Zajac JD, et al. Feminizing hormone therapy prescription patterns and cardiovascular risk factors in aging transgender individuals in Australia. Front Endocrinol. 2021;12:667403.

    Article  Google Scholar 

  4. Ott J, Kaufmann U, Bentz EK, Huber JC, Tempfer CB. Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy. Fertil Steril. 2010;93:1267–72.

    Article  Google Scholar 

  5. Seal LJ, Franklin S, Richards C, Shishkareva A, Sinclaire C, Barrett J. Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens. J Clin Endocrinol Metab. 2012;97:4422–8.

    Article  CAS  Google Scholar 

  6. Pyra M, Casimiro I, Rusie L, Ross N, Blum C, Keglovitz Baker K, et al. An observational study of hypertension and thromboembolism among transgender patients using gender-affirming hormone therapy. Transgend Health. 2020;5:1–9.

    Article  Google Scholar 

  7. Denby KJ, Cho L, Toljan K, Patil M, Ferrando CA. Assessment of cardiovascular risk in transgender patients presenting for gender-affirming care. Am J Med. 2021;134:1002–8.

    Article  Google Scholar 

  8. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief. 2020:1–8.

  9. van Kesteren PJ, Asscheman H, Megens JA, Gooren LJ. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol. 1997;47:337–42.

    Article  Google Scholar 

  10. Pharr JR, Batra K. Propensity score analysis assessing the burden of non-communicable diseases among the transgender population in the United States using the behavioral risk factor surveillance system (2017–2019). Healthcare. 2021;9:696.

    Article  Google Scholar 

  11. Connelly PJ, Clark A, Touyz RM, Delles C. Transgender adults, gender-affirming hormone therapy and blood pressure: A systematic review. J Hypertens. 2021;39:223–30.

    Article  CAS  Google Scholar 

  12. van Velzen DM, Paldino A, Klaver M, Nota NM, Defreyne J, Hovingh GK, et al. Cardiometabolic effects of testosterone in transmen and estrogen plus cyproterone acetate in transwomen. J Clin Endocrinol Metab. 2019;104:1937–47.

    Article  Google Scholar 

  13. Alzahrani T, Nguyen T, Ryan A, Dwairy A, McCaffrey J, Yunus R, et al. Cardiovascular disease risk factors and myocardial infarction in the transgender population. Circ Cardiovasc Qual Outcomes. 2019;12:e005597.

    Article  Google Scholar 

  14. Feldman JL, Luhur WE, Herman JL, Poteat T, Meyer IH. Health and health care access in the US transgender population health (TransPop) survey. Andrology. 2021;9:1707–18.

    Article  Google Scholar 

  15. Kyinn M, Banks K, Leemaqz SY, Sarkodie E, Goldstein D, Irwig MS. Weight gain and obesity rates in transgender and gender-diverse adults before and during hormone therapy. Int J Obes (Lond). 2021;45:2562–9.

    Article  CAS  Google Scholar 

  16. Maraka S, Singh Ospina N, Rodriguez-Gutierrez R, Davidge-Pitts CJ, Nippoldt TB, Prokop LJ, et al. Sex steroids and cardiovascular outcomes in transgender individuals: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2017;102:3914–23.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Michael S. Irwig

  2. Harvard Medical School, Boston, MA, USA

    Michael S. Irwig

Authors
  1. Michael S. Irwig
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MSI is the sole contributor of this work.

Corresponding author

Correspondence to Michael S. Irwig.

Ethics declarations

Competing interests

The author declares no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Irwig, M.S. Hypertension in transgender individuals. J Hum Hypertens (2022). https://doi.org/10.1038/s41371-022-00721-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41371-022-00721-w

This article is cited by

Search

Advanced search

Quick links