Testosterone Use May Raise Heart Risks for Trans Men

As they age, transgender men and other trans or nonbinary people who use testosterone therapy to make their physical appearance match their gender identity may be more likely to experience cardiovascular events like heart attacks than cisgender men (men who identify as the sex they were assigned at birth), an emerging body of evidence suggests.

Testosterone therapy, often simply called “T,” is associated with cardiovascular risk factors like high blood pressure, elevated levels of “bad” (LDL) cholesterol that clogs arteries, and lower levels of “good” (HDL) cholesterol that helps keep arteries free of debris, says Nina Stachenfeld, PhD, director of the Laboratory for Metabolic Testing and Performance at the Yale School of Medicine in New Haven, Connecticut.

Over time, transgender men and transmasculine people taking testosterone may also have an increased risk of blood clots compared with cisgender women, as well as endothelial dysfunction, a condition that develops when the inner lining of small arteries no longer expands and contracts efficiently, says Dr. Stachenfeld. Endothelial dysfunction can then lead to atherosclerosis, a hardening and stiffening of the arteries that can cause heart attacks and strokes.

What Is Masculinizing Hormone Therapy

When trans people take testosterone as part of a medical gender transition, they can experience physical changes similar to what cisgender men undergo during puberty, including the deepening of their voice and hair growth on their chest or face, according to the Gender Affirming Health Program at the University of California San Francisco (UCSF). Testosterone can also suppress menstrual cycles.