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Gender-affirming care in adolescents and young adults with cardiovascular conditions: clinical considerations in a limited evidence landscape

Published online by Cambridge University Press:  27 August 2025

Thomas Agostini
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington, USA
Eyal Sagiv*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington, USA
Juanita K. Hodax
Affiliation:
Division of Endocrinology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington, USA
Andrew R. Pistner
Affiliation:
Department of Cardiology, University of Washington Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
Jason F. Deen
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington, USA Department of Cardiology, University of Washington Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
*
Corresponding author: Eyal Sagiv; Email: eyal.sagiv@seattlechildrens.org

Abstract

Gender-affirming care is a multi-faceted healthcare provided to transgender and gender diverse individuals to support their physical and mental health. As more adolescents and young adults may be interested in various gender care options, cardiologists should have familiarity with the medical and surgical therapies offered and the risk and considerations these may have, particularly for youth with the history of congenital or acquired cardiovascular disease. The existing literature on exogenous hormone therapy, for the general population and transgender individuals specifically, is by large limited to the adult population, with little relevant information for younger individuals. Current evidence indicates several potential cardiovascular implications to consider with gender-affirming hormone therapy without documented morbidity or clear contraindication for its use. These include the risk of thromboembolism, atherosclerotic and coronary artery disease, hypertension, and dyslipidemia among others. This review summarises existing evidence to assist in navigating the risks and therapeutic options so that offering gender-affirming care can be considered and delivered safely for adolescents and young adults with cardiovascular conditions and makes recommendations for future research.

Information

Type
Review
Copyright
© The Author(s), 2025. Published by Cambridge University Press

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