호르몬을 쓰는 트랜스 여성은 남성보다 혈전 4.5배, 뇌졸중도 더 많음. 트랜스 남성은 여성보다 심장마비가 더 많음

호르몬 치료를 받는 트랜스젠더 개인의 급성 심혈관 사건 발생

Authors: Nienke M. Nota, Chantal M. Wiepjes, Christel J.M. de Blok, Louis J.G. Gooren, Baudewijntje P.C. Kreukels, Martin den Heijer
Journal: Circulation
Year: 2019
Source: https://doi.org/10.1161/CIRCULATIONAHA.118.038584

Summary

This short report used records from the Amsterdam gender clinic, which treats most trans people in the Netherlands. It counted strokes, heart attacks and blood clots in nearly 3,900 people on cross-sex hormones over about 8 to 9 years, and compared them with expected rates in the general population. Trans women had about 4.5 to 5.5 times the expected rate of blood clots and about twice the expected rate of stroke, and more heart attacks than women (but not men). Trans men had more heart attacks than women but about the same as men. Blood-clot risk was lower, though still raised, in trans women who started after 2001, when an older estrogen was dropped. The long follow-up makes this useful, but the comparison is with outside population figures, smoking was not accounted for, and the trans men's results rest on few events.

Key findings

연구에는 암스테르담 성별 클리닉에서 치료받은 트랜스 여성 2,517명과 트랜스 남성 1,358명이 포함되었고 평균 약 9년과 8년 추적했습니다.
트랜스 여성은 정맥 혈전이 73건으로, 여성에서 예상되는 비율의 5.5배, 남성의 4.5배였습니다.
트랜스 여성은 뇌졸중 29건(여성 비율의 2.4배, 남성의 1.8배), 심장마비 30건(여성 비율의 2.6배, 남성보다는 높지 않음)이 있었습니다.
트랜스 남성은 심장마비가 11건으로, 여성에서 예상되는 비율의 3.7배이고 남성에서 예상되는 것과 같았습니다.
트랜스 남성은 뇌졸중 6건과 혈전 2건뿐이었고, 남성이나 여성과 분명한 차이가 없었습니다.
2001년 이전에 시작한 트랜스 여성(오래된 에스트로겐인 에티닐에스트라디올이 대체되기 전)을 제외하면 혈전 비율은 여성의 약 3.9배, 남성의 3.4배로 낮아졌고, 다른 위험은 낮아지지 않았습니다.
연구 대상자의 43~46%가 흡연했고 이를 고려할 수 없었습니다.

Conclusion

Considering the limitations, the authors conclude that the incidences of strokes and VTEs are higher in transwomen receiving hormone therapy than in both reference women and men, and that transwomen and transmen receiving hormone therapy are at higher risk of myocardial infarction than reference women. They urge physicians and transgender individuals to be aware of this increased cardiovascular risk and to reduce risk factors such as smoking.

Methodological limitations

Very short report: It was published as a two-page letter with few details, so how events were defined, who was left out and how results were checked are only briefly described.
Outside comparison only: Rates were compared with figures from separate Dutch and Norwegian population studies that found cases in different ways, not with a matched group of similar people.
Other risk factors ignored: The authors could not account for smoking (43–46% smoked) or life stresses, and weight, diabetes and other risk factors were not accounted for either.
Events may have been missed: Events were found by searching clinic files for doctors' letters. Events treated elsewhere and not reported back may have been missed, so true rates are probably higher.
Older drugs: Much of the follow-up involved older drugs (ethinylestradiol and high-dose cyproterone). Leaving out early starters lowered blood-clot risk, so the headline figure overstates risk on today's drugs, though risk was still raised.
Few events in trans men: Results rest on 6 strokes, 11 heart attacks and 2 blood clots, so the figures are very uncertain.
Some people left out: People who stopped hormones for long periods or switched between male and female hormones (such as some detransitioners) were excluded, as were 52 people with a past event.
Uneven follow-up: The typical person was followed for only about 4 to 6 years, much less than the average, so much of the data comes from a minority treated for a long time.
One clinic: Everyone was treated at one specialist centre, so results may not apply outside the Netherlands.

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Summary

Key findings

Conclusion