A new study from the Netherlands has provided a clearer understanding of how gender-affirming hormone therapy affects heart health in transgender people. Published in the European Heart Journal on November 4, 2025, the research followed thousands of transgender individuals and compared their risk of major cardiovascular events to that of the general Dutch population.
The Study at a Glance
Researchers from the Amsterdam University Medical Centre examined medical records of 2,714 transgender women and 1,617 transgender men who began hormone therapy between 1972 and 2018. They tracked heart attacks, strokes, and blood clots from 2012 through 2022 and compared these outcomes with those of cisgender men and women. What made this study unique is that it also accounted for socioeconomic status (factors like income, education, and employment), which previous studies often overlooked.
The team found that transgender women had a lower risk of heart attacks than cisgender men and a similar risk compared with cisgender women once social and economic factors were considered. Their risk of stroke was roughly equal to both groups, but their risk of blood clots remained higher. Transgender men, however, showed a different pattern: their risk of heart attack and stroke was significantly higher than that of cisgender women, though comparable to cisgender men.
What the Findings Mean
For transgender women, the results are encouraging in some ways. Modern estrogen-based hormone therapy did not appear to increase the risk of heart attacks or strokes compared to the general population. However, the elevated risk of blood clots remains a concern, especially for individuals who smoke, are less active, or have other underlying conditions. The study supports careful monitoring by healthcare providers, including regular blood work and attention to clotting risk factors.
Transgender men, on the other hand, showed a clear increase in heart-related events compared to cisgender women. Testosterone therapy can raise red blood cell counts and affect cholesterol levels, which may contribute to these findings. The study suggests that regular cardiovascular screenings, maintaining a healthy diet, and managing blood pressure could be especially important for trans men.
The inclusion of socioeconomic status in the analysis also matters. Many transgender individuals face barriers such as discrimination and unstable employment, which can influence overall health outcomes. The researchers found that while social and economic differences explained only a small part of the variation in cardiovascular risk, these factors still shape access to healthcare and long-term well-being.
The Bottom Line
The study’s authors caution that the results should not cause alarm or discourage anyone from starting or continuing hormone therapy. The research is observational and cannot prove direct cause and effect. Hormone regimens have also evolved over the decades; earlier patients may have used formulations that carried higher risks than those prescribed today.
Still, this large-scale analysis provides valuable evidence that cardiovascular health should be a core part of gender-affirming care. Trans women may benefit from periodic clotting assessments, while trans men should work with providers to monitor heart health more closely.
For the transgender community, the message is not to fear hormones but to stay informed. Living authentically includes caring for the body that carries you forward. As this research reminds us, gender-affirming care and overall health go hand in hand and thriving in your truth means making both a priority.
