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Background <p>Gender-affirming hormone therapy has shown benefits in alleviating gender-related distress and enhancing overall well-being. However, its effects on cardiovascular health are not yet fully understood.</p> Purpose <p>To evaluate heart rate variability, a preclinical marker of cardiovascular disease, both at rest and during sympathetic nervous system stimulation in transgender people undergoing gender-affirming hormone therapy, compared with healthy cisgender controls matched by age and body mass index.</p> Methods <p>The study sample included 26 transgender patients (12 transgender women and 14 transgender men) and 25 cisgender controls (12 cisgender men and 13 cisgender women). All participants underwent a 30-minute electrocardiogram recording to assess heart rate variability under resting conditions and during mental stress test.</p> Results <p>Compared with their cisgender counterparts, transgender men exhibited reduced cardiac autonomic modulation of cardiac function during stress. In contrast, transgender women did not show significant differences in heart rate variability when compared to controls.</p> Conclusion <p>These findings suggest that testosterone therapy may impair autonomic cardiovascular responses in transgender men, particularly under conditions of sympathetic activation, whereas estradiol-based regimens showed no significant impact in transgender women. Further research is needed to determine whether these early changes in cardiac autonomic regulation may predict future cardiovascular events in this population.</p>

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Heart rate variability in transgender people receiving Gender-Affirming hormone therapy

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Roberta MCM Allgayer,
  • Larissa Horos Bueno,
  • Eliane Dias da Silva,
  • Tayane Muniz Fighera,
  • Ruy Silveira Moraes,
  • Poli Mara Spritzer

摘要

Background

Gender-affirming hormone therapy has shown benefits in alleviating gender-related distress and enhancing overall well-being. However, its effects on cardiovascular health are not yet fully understood.

Purpose

To evaluate heart rate variability, a preclinical marker of cardiovascular disease, both at rest and during sympathetic nervous system stimulation in transgender people undergoing gender-affirming hormone therapy, compared with healthy cisgender controls matched by age and body mass index.

Methods

The study sample included 26 transgender patients (12 transgender women and 14 transgender men) and 25 cisgender controls (12 cisgender men and 13 cisgender women). All participants underwent a 30-minute electrocardiogram recording to assess heart rate variability under resting conditions and during mental stress test.

Results

Compared with their cisgender counterparts, transgender men exhibited reduced cardiac autonomic modulation of cardiac function during stress. In contrast, transgender women did not show significant differences in heart rate variability when compared to controls.

Conclusion

These findings suggest that testosterone therapy may impair autonomic cardiovascular responses in transgender men, particularly under conditions of sympathetic activation, whereas estradiol-based regimens showed no significant impact in transgender women. Further research is needed to determine whether these early changes in cardiac autonomic regulation may predict future cardiovascular events in this population.