Introduction: The safety and efficacy of feminising hormone therapy in older transgender (trans) individuals is unclear. Current recommendations suggest transdermal estradiol beyond the age of 45 years, especially if cardiometabolic risk factors are present. We aimed to evaluate feminising hormone therapy regimens and cardiovascular risk factors in older trans individuals.
Methods: A retrospective cross-sectional analysis was undertaken of trans individuals attending a primary or secondary care clinic in Melbourne, Australia who had received estradiol for at least six months duration. Serum estradiol concentration was measured by immunoassay. Outcomes were: (1) feminising hormone regimens and serum estradiol concentrations by age group: (a) ≥45 years, (b) <45 years, and (2) prevalence of cardiometabolic risk factors in individuals ≥45 years.
Results: 296 individuals were stratified by age group: ≥45 years (n=55) and <45 years (n=241). There was no difference in median serum estradiol concentration between groups (328 pmol/L vs. 300 pmol/L, p=0.22). However, there was a higher proportion of individuals ≥45 years treated with transdermal estradiol (31% vs. 8%, p<0.00001). Of those treated with oral estradiol, the median dose was lower in the ≥45 years group (4mg vs. 6mg, p=0.01). The most prevalent cardiometabolic risk factor in the ≥45 years group was hypertension (29%), followed by current smoking (24%), obesity (20%), dyslipidaemia (16%) and diabetes (9%).
Conclusions: A greater proportion of trans individuals ≥45 years of age were treated with transdermal estradiol. Of those who received oral estradiol, the median dose was lower. This is important given the high prevalence of cardiometabolic risk factors in this age group, however cardiovascular risk management guidelines in this patient cohort are lacking.