Cardiovascular health and gender minority stress in transgender and gender diverse adults: A cross-sectional study.

BACKGROUND

Transgender and gender diverse (TGD) people may take gender affirming hormone therapy (GAHT) to affirm their gender identity and improve quality of life. The cardiovascular health (CVH) impacts of GAHT are not well described. TGD individuals may also experience gender minority stress (GMS), typically caused by discrimination and transphobia, which may adversely affect CVH. The purpose of this study is to evaluate the CVH and gender minority stress of TGD adults receiving GAHT.

METHODS

This observational study was approved by the Emory University Institutional Review Board. TGD adults (18-75 years) were recruited from Emory endocrinology outpatient clinics. CVH was measured using American Heart Association's Life's Essential 8 (LE8) tool. Data from electronic medical records were combined with administered questionnaire responses to calculate LE8 and GMSR scores.

RESULTS

From October 2023 to April 2025, 98 TGD adults were screened and 95 were enrolled. Nine participants were excluded for incomplete questionnaires and/or medical records. Of 86 participants (mean age: 33.8 ± 1.4 years) with complete data, the mean LE8 score was 69.4 ± 1.3 and there was no significant difference based on sex assigned at birth. The lowest three sub scores were diet (37.7 ± 1.8), body mass index (BMI) (61.6 ± 4.0), and physical activity (63.4 ± 3.9), matching the lowest three subscores found in the general United States population. No statistically significant associations were found between GMSR and LE8 scores in this study.

CONCLUSIONS

Factors beyond hormone therapy such as diet, BMI, and physical activity should be considered for driving CVH deficits in the TGD adult population. Further research is needed to understand longitudinal changes in CVH and the impact of GMS on CVH.