TY - JOUR
T1 - Gender-affirming hormone therapy and its impact on myocardial mass and cardiac function
T2 - a prospective magnetic resonance cohort study on transgender men and women
AU - Deischinger, Carola
AU - Slukova, Dorota
AU - Kosi-Trebotic, Lana
AU - Harreiter, Jürgen
AU - Nopp, Stephan
AU - Just, Ivica
AU - Klepochova, Radka
AU - Krššák, Martin
AU - Trattnig, Siegfried
AU - Kaufmann, Ulrike
AU - Kautzky-Willer, Alexandra
N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of European Society of Endocrinology.
PY - 2025/3/27
Y1 - 2025/3/27
N2 - OBJECTIVE: Differences in cardiac parameters such as myocardial mass, left ventricular ejection fraction (LVEF), cardiac output, and brain natriuretic peptide (NT-proBNP) levels between cisgender men and women are well established. No evidence exists regarding changes in myocardial mass or cardiac function parameters in transgender individuals undergoing gender-affirming hormone therapy (GAHT).DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOMES: A prospective study enrolling transgender individuals under GAHT (20 individuals assigned female at birth [AFAB] and 15 assigned male at birth [AMAB]) was conducted at the Medical University of Vienna from 2019 to 2022. A 3-Tesla electrocardiogram-gated magnetic resonance imaging measured myocardial mass, LVEF, and other cardiac function parameters before GAHT and at 6-month follow-up. Myocardial lipid content was quantified using magnetic resonance spectroscopy.RESULTS: In AFAB, myocardial mass increased significantly after 6 months of GAHT from mean (±SD) 48 (±8) g/m2 at baseline to 54 (±7) g/m2 at follow-up (P = .011). Individuals assigned male at birth showed a nonsignificant decrease of 4 (±14) g/m2 in myocardial mass. In both groups, no significant changes were noted in LVEF, stroke volume, cardiac output, or peak filling rate. Neither testosterone (AFAB: r = -0.127, P = .679; AMAB: r = -0.127, P = .679) nor estradiol levels (AFAB: r = -0.154, P = .616; AMAB: r = -0.154, P = .616) nor body mass index was related to myocardial mass at follow-up. Brain natriuretic peptide levels in AFAB were significantly reduced at follow-up (from median [IQR] 41 [26-57] to 19 [12-34] pg/mL).CONCLUSIONS: Myocardial mass increased, while NT-proBNP levels decreased significantly in AFAB after 6 months of GAHT. However, no significant changes in cardiac function were noted in AMAB and AFAB.REGISTRATION: ClinicalTrials.gov: NCT06245681 (registered 07 February 2024, https://classic.clinicaltrials.gov/ct2/show/NCT06245681).
AB - OBJECTIVE: Differences in cardiac parameters such as myocardial mass, left ventricular ejection fraction (LVEF), cardiac output, and brain natriuretic peptide (NT-proBNP) levels between cisgender men and women are well established. No evidence exists regarding changes in myocardial mass or cardiac function parameters in transgender individuals undergoing gender-affirming hormone therapy (GAHT).DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOMES: A prospective study enrolling transgender individuals under GAHT (20 individuals assigned female at birth [AFAB] and 15 assigned male at birth [AMAB]) was conducted at the Medical University of Vienna from 2019 to 2022. A 3-Tesla electrocardiogram-gated magnetic resonance imaging measured myocardial mass, LVEF, and other cardiac function parameters before GAHT and at 6-month follow-up. Myocardial lipid content was quantified using magnetic resonance spectroscopy.RESULTS: In AFAB, myocardial mass increased significantly after 6 months of GAHT from mean (±SD) 48 (±8) g/m2 at baseline to 54 (±7) g/m2 at follow-up (P = .011). Individuals assigned male at birth showed a nonsignificant decrease of 4 (±14) g/m2 in myocardial mass. In both groups, no significant changes were noted in LVEF, stroke volume, cardiac output, or peak filling rate. Neither testosterone (AFAB: r = -0.127, P = .679; AMAB: r = -0.127, P = .679) nor estradiol levels (AFAB: r = -0.154, P = .616; AMAB: r = -0.154, P = .616) nor body mass index was related to myocardial mass at follow-up. Brain natriuretic peptide levels in AFAB were significantly reduced at follow-up (from median [IQR] 41 [26-57] to 19 [12-34] pg/mL).CONCLUSIONS: Myocardial mass increased, while NT-proBNP levels decreased significantly in AFAB after 6 months of GAHT. However, no significant changes in cardiac function were noted in AMAB and AFAB.REGISTRATION: ClinicalTrials.gov: NCT06245681 (registered 07 February 2024, https://classic.clinicaltrials.gov/ct2/show/NCT06245681).
KW - Humans
KW - Female
KW - Male
KW - Prospective Studies
KW - Adult
KW - Transgender Persons
KW - Magnetic Resonance Imaging
KW - Heart/drug effects
KW - Gender-Affirming Procedures/methods
KW - Ventricular Function, Left/drug effects
KW - Myocardium/pathology
KW - Testosterone
KW - Stroke Volume/drug effects
KW - Natriuretic Peptide, Brain/blood
KW - Cohort Studies
KW - Hormone Replacement Therapy
KW - Young Adult
KW - Peptide Fragments
U2 - 10.1093/ejendo/lvaf057
DO - 10.1093/ejendo/lvaf057
M3 - Journal article
C2 - 40153614
SN - 0804-4643
VL - 192
SP - 429
EP - 436
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
IS - 4
ER -