Cardiovascular Research Falling Short for Transgender Community
Despite rising awareness of gender diversity in medicine, the transgender community remains largely unrepresented in cardiovascular research. Transgender individuals have not been included or identified in clinical trials and poorly served by existing health data focused primarily on cisgender (individuals who identify as the sex they were assigned at birth) men.
"As cardiologists, the decisions we make regarding patient care are largely based on research that predominantly included cisgender men," said Margaret McEntegart, MD, Director of Complex PCI and CTO Programs and the Cardiac Catheterization Laboratories at CUIMC/NewYork-Presbyterian Hospital. "While cisgender women are under-represented, making up 10-20% of most study populations, transgender patients have largely been excluded".
Transgender is a term that describes individuals who identify as a sex other than the one they were assigned at birth. That includes transgender men (assigned as female sex at birth (AFAB) but identify as men) and transgender women (assigned male sex at birth (AMAB) but identify as women).
Within the transgender community, gender-affirming hormone therapy (GAHT) is commonly used to achieve secondary sexual characteristics that reflect the gender they identify with. There has been very little research exploring how GAHT affects heart health. Limited evidence suggests that estrogen may raise the risk of blood clots or stroke in some trans women, and testosterone could increase some cardiovascular risks in transgender men. With a poor understanding of how these therapies impact cardiovascular health, the need for greater research is clear.
Current Research Lacks Inclusiveness
While studies have started to include a more diverse population, most still use binary categories—male or female—without accounting for factors like gender identity, sex assigned at birth, or GAHT use. This limited categorization means that the transgender community is either left out or misclassified, making it nearly impossible to draw reliable conclusions about their cardiovascular risks.
A recent case study highlights this issue: a 31-year-old transgender man presented with chest pain radiating to the left arm, shoulder, and neck. He was diagnosed with a myocardial infarction (heart attack) despite having no clear cardiovascular risk factors.
Although the man was using GAHT in the form of intramuscular testosterone injections, the lack of data related to GAHT's cardiovascular impact left providers without relevant guidance. The man was treated with medical therapy and released.
Because there is insufficient evidence to know if or how his testosterone injections were connected to his cardiac event, he continued his GAHT.
"This patient's experience really got me thinking about our lack of understanding about the impact of hormone therapy on cardiovascular risk, and how to manage hormone therapy after a cardiac event," said Dr. McEntegart.
An Underserved Community
These clinical research gaps are compounded by social factors. The transgender community frequently faces discrimination in healthcare settings, leading to delays in preventive care like blood pressure and cholesterol screening. Many also live with chronic stress, financial instability, or limited access to health insurance—well-established risk factors for cardiovascular disease.
There are no formal cardiovascular screening guidelines for the transgender population. Doctors must rely on general population data that may not reflect the unique needs of transgender patients. As a result, transgender patients are left at a dangerous disadvantage.
"As a cisgender woman and cardiologist working on gender inequality in cardiovascular care, this case made me acutely aware of the even greater vulnerability of transgender patients," said Dr. McEntegart.
This case underscores the need for targeted cardiovascular research that focuses on the transgender population, as well as inclusion and proper identification in broader studies.
Related