Testosterone and vascular health: caution recommended for long-term therapy

Testosterone therapy has many applications, from hypogonadism to gender reassignment surgery. A study looked into vascular system implications.

Study focused on transgender men

Long-term therapy: not only relevant for transgender men

The reasons for people take testosterone over a long-term can have different reasons. As the present study shows, it can be a supportive measure on the way to gender reassignment. But there are also other reasons: Men with congenital or acquired hypogonadism often receive testosterone therapy. Also not to be neglected is the number of those who take testosterone that they have acquired without a prescription - for example, to achieve a certain appearance. The data presented is therefore relevant for all people on testosterone therapy.

Vascular stiffness as a marker of vascular health

Arterial stiffness is directly related to the risk of cardiovascular complications and events. The more flexible a vessel is, the healthier it is. This means that the risk of stroke and heart attack decreases. Conversely, however, this also means that the stiffer an artery is, the higher the cardiovascular risk.

Testosterone has negative effects on blood vessels

The study authors took advantage of this by looking at carotid-femoral pulse wave velocity (cf-PWV) in 33 transgender men who had received long-term testosterone injections. The results were then compared with those of matched cisgender men and women.

The result: vascular stiffness significantly increased in the testosterone group compared to the controls. For all groups, there was a positive correlation between increased arterial stiffness and age.

Implications for vascular health

The data strongly suggest that long-term therapy with testosterone has negative effects on vascular health. This is true for both cis and transgender people. Therefore, it is important to conduct appropriate cardiovascular risk management to protect those receiving treatment from complications such as stroke and heart attack. It is equally important to take an appropriate medical history, because not every testosterone intake has been prescribed by a physician.