From the Guidelines
Testosterone therapy does not appear to significantly increase the risk of stroke in female-to-male transgender patients, based on current evidence. According to a 2024 guideline from the American Heart Association/American Stroke Association 1, a cohort study of 2842 transfeminine people and 2118 transmasculine people found that stroke incidence in the transmasculine cohort was similar to that in cisgender populations. The study suggests that the evidence is insufficient to allow conclusions about risk among transmasculine participants, but it does not indicate a higher risk of stroke in this group.
Some key points to consider when evaluating the risk of stroke in female-to-male transgender patients on testosterone therapy include:
- The observational design of published studies indicating a potentially increased risk of stroke in transfeminine individuals taking gender-affirming hormone therapy should be interpreted with caution, as these studies lack important details on hormone regimens, hormone levels, lifestyle factors, and external minority stress risk factors 1.
- Interventions on known vascular risk factors such as tobacco use and hypertension would likely be effective at reducing stroke risk in this population, although specific intervention studies inclusive of transgender people are lacking 1.
- Transgender men on testosterone therapy should be monitored for cardiovascular risk factors such as hypertension, dyslipidemia, and polycythemia, and those with pre-existing cardiovascular risk factors should receive particularly careful evaluation and monitoring.
- To minimize potential risks, transgender men should maintain testosterone levels within the normal male physiologic range, avoid smoking, maintain a healthy weight, exercise regularly, and attend regular medical check-ups to monitor cardiovascular health 1.
From the Research
Testosterone Therapy and Stroke Risk in Female-to-Male Transgender Patients
- The available evidence does not directly address the risk of stroke associated with testosterone therapy in female-to-male transgender patients 2, 3, 4.
- However, a study on testosterone replacement therapy and cardiovascular events suggests that older patients and those susceptible to cardiovascular diseases may be at risk with a testosterone prescription 5.
- Another study on gender-affirming hormone therapy found that the use of certain estrogens in trans women induces an increased risk of myocardial infarction and stroke, but this is not directly applicable to female-to-male transgender patients 6.
- The current evidence on testosterone therapy for transgender men highlights potential undesired effects and risks, including increased systolic blood pressure, but does not specifically address the risk of stroke 4.
- Overall, there is a lack of direct evidence on the risk of stroke associated with testosterone therapy in female-to-male transgender patients, and further research is needed to fully understand this potential risk 2, 3, 4, 5, 6.