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부산대학교 의과대학

Int. J. Transgender Health, Published online: 01 Jan 2026 | https://doi.org/10.1080/26895269.2025.2608831 Gender-affirming hormone therapy and cardiovascular risk: an umbrella review of meta-analyses

Hyunoh Moon ^a,#, Sejin Park ^a,#, Yeongin Lee ^a,#, Seo Hyun Lee ^b, Chaeseong Lim ^c, Su-Yeon Cho ^d,e, Yujin Kwon ^f, Won Ho Cho ^g, Hyun-Joo Kim^h,i, Won Kyu Kim ^d,e,f,*, Kihun Kim^j,m,*and Yun Hak Kim ^k,l,*

^aSchool of Medicine, Pusan National University, Yangsan, Republic of Korea
^bDepartment of Molecular Biology, College of Natural Sciences, Pusan National University, Busan, Republic of Korea

^cDepartment of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea

^dNatural Product Research Center, Korea, Institute of Science and Technology (KIST), Gangneung, Republic of Korea

^eDivision of Natural Products Applied Science, University of Science and Technology (UST), Daejeon, Republic of Korea

^fDepartment of Convergence Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea

^gDepartment of Neurosurgery, Pusan National University Hospital, Biomedical Institute of Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Republic of Korea
^hDepartment of Periodontology, Dental and Life Science Institute, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
ⁱDepartment of Periodontics and Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Republic of Korea
^jDepartment of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
^kDepartment of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea

^lDepartment of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea

^mResearch Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea

^#These authors contributed equally

^*Corresponding authors: correspondence to Won Kyu Kim, Kihun Kim or Yun Hak Kim

Abstract

Introduction: Gender-affirming hormone therapy (GAHT) is widely used to help transgender individuals align physical traits with gender identity, yet concerns remain regarding its cardiovascular safety. Previous reviews have produced conflicting findings, often constrained by small sample sizes, short follow-up, and heterogeneous hormone regimens. This umbrella review synthesizes current meta-analytic evidence on cardiovascular outcomes of GAHT.

Methods: We followed PRISMA guidelines and searched Embase, MEDLINE, Scopus, Web of Science, and ScienceDirect through February 2025. Eligible studies were meta-analyses reporting quantitative outcomes of GAHT. Data were extracted on lipid profiles, blood pressure, hematocrit, and cardiovascular events. Pooled estimates were calculated using inverse-variance methods. Study quality was assessed with AMSTAR 2, and evidence certainty was graded with GRADE.

Results: Eight meta-analyses including 30,789 participants were reviewed. Among individuals assigned female at birth (AFAB), GAHT increased low-density lipoprotein, triglycerides, and total cholesterol and decreased high-density lipoprotein. Blood pressure showed no significant change. Among individuals assigned male at birth (AMAB) receiving estradiol, lipid effects were inconsistent. Hematocrit increased predominantly in the AFAB group. VTE prevalence was 0.01 in AFAB and 0.02 in AMAB, while risks of myocardial infarction and stroke were not significantly different. The overall quality of evidence ranged from moderate to low.

Conclusions: GAHT affects lipid metabolism, especially among AFAB individuals, but current data do not indicate a significant increase in cardiovascular events. Given the short follow-up and heterogeneity of study designs, further high quality research is warranted to guide clinical care.

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