Gender-affirming estrogen therapy route of administration and cardiovascular risk: a systematic review and narrative synthesis
Keila Turino Miranda, Cindy Z. Kalenga, Nathalie Saad, Sandra M. Dumanski, David Collister, Chantal L. Rytz, Diane Lorenzetti, Danica H. Chang, Caitlin McClurg, Darlene Y. Sola, Sofia B. Ahmed
Abstract
This study is the first to summarize the potential effect of nonoral versus oral gender-affirming estrogen therapy use on cardiovascular risk factors in transgender women or nonbinary or gender-diverse individuals. Heterogeneity of studies in reporting gender-affirming estrogen therapy formulation, dose, and duration of exposure limits quantification of the effect of gender-affirming estrogen therapy on all-cause and cardiovascular mortality, adverse cardiovascular events, and cardiovascular risk factors. This systematic review highlights the needs for large prospective cohort studies with appropriate stratification of gender-affirming estrogen therapy by dose, formulation, administration route, and sufficient follow-up and analyses to limit selection bias to optimize the cardiovascular care of transgender, nonbinary, and gender-diverse individuals.