From the Guidelines
Transgender women on hormone replacement therapy (HRT) who experience tachycardia should consult their healthcare provider for evaluation, as this could be related to their hormone regimen, particularly estrogen therapy, which can occasionally cause heart rate increases, especially at higher doses 1. The provider may recommend reducing the estradiol dose (typically to 2-6 mg daily oral or 0.1-0.2 mg/day transdermal) or switching from oral to transdermal administration to avoid first-pass liver metabolism. Some key points to consider in the evaluation and management of tachycardia in transgender women on HRT include:
- Estrogen therapy, particularly estradiol, can cause heart rate increases, especially at higher doses 1
- Anti-androgens like spironolactone (25-200 mg daily) can also cause electrolyte imbalances that affect heart rate
- The healthcare provider should check potassium levels, blood pressure, thyroid function, and perform an ECG to rule out other causes
- Lifestyle modifications such as reducing caffeine, alcohol, and nicotine consumption, staying hydrated, and managing stress can help manage tachycardia
- If symptoms persist despite these adjustments, the provider might consider adding a beta-blocker like propranolol or metoprolol at a low dose, ensuring it doesn't interact with existing medications Tachycardia warrants attention because estrogen therapy slightly increases the risk of cardiovascular events, particularly in those with pre-existing conditions or who smoke 1. It is essential to note that the use of gender-affirming hormone therapy may be associated with cardiometabolic changes, but the field of CV health research in TGD persons remains limited 1. Therefore, a comprehensive approach to evaluating and managing tachycardia in transgender women on HRT is necessary to minimize the risk of cardiovascular events and improve overall health outcomes.
From the Research
HRT and Tachycardia in Transgendered Females
- The relationship between hormone replacement therapy (HRT) and tachycardia in transgendered females is a topic of ongoing research, with several studies investigating the cardiovascular effects of HRT in this population 2, 3, 4, 5.
- A 2019 study found that HRT in trans women may increase the risk of cardiac arrhythmias, including tachycardia, due to the effects of sex hormones on the cardiovascular system 2.
- Another study published in 2020 noted that the cardiovascular effects of HRT in transgender individuals are controversial and require further research, particularly in terms of the risk of cardiovascular disease and events such as tachycardia 3.
- A 2021 study assessed the cardiovascular risk in transgender patients presenting for gender-affirming care and found that this population is at high baseline cardiovascular risk, with increased rates of mental health disorders, substance use, and undiagnosed comorbidities such as hypertension and dyslipidemia 4.
- A 2024 review discussed the cardiometabolic impact and clinical considerations of gender-affirming hormone therapy (GAHT) on cardiovascular risk in transgender patients, highlighting the need for further research on the effects of GAHT on cardiovascular outcomes, including tachycardia 5.
- An older study from 1989 compared the effects of estradiol valerate and low-dose ethinyl estradiol on haemostasis parameters and found that ethinyl estradiol may increase the risk of hypercoagulability and cardiovascular disease, which could potentially contribute to the development of tachycardia 6.