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• Posted November 6, 2025

Transgender Women's Heart Health Not Harmed By Hormone Therapy

Transgender women using estradiol for their transition don’t run an increased risk of heart attack or stroke, a new study says.

In fact, their hormone treatment might have a protective effect on the heart and blood vessels compared to cisgender men, researchers reported Nov. 4 in the European Heart Journal.

However, transgender men using testosterone for their transition do have an increased risk of heart attack and stroke compared to cisgender women, the study found.

"If we have a better understanding of the factors that play a role, we can improve care for transgender people,” said lead researcher Lieve Mees van Zijverden, a physician-researcher at Amsterdam University Medical Center.

“The number of transgender people who use hormones is growing worldwide. This group is also getting older,” van Zijverden said in a news release. “This means that cardiovascular disease will become an increasingly important point of attention in the future."

In transgender people, their sex at birth does not match their experienced gender identity. Many choose hormone treatment to develop physical characteristics that better align with their gender identity, like breast growth or a lower voice, researchers said in background notes.

But there have been ongoing concerns that this hormone treatment might impact people’s heart health.

For this new study, researchers analyzed data from more than 4,000 transgender people in The Netherlands, comparing their health to that of the general population and cisgender people not taking hormone therapy.

Results showed that transgender women taking estradiol had a 50% lower risk of heart attack and similar risk of stroke, compared to cisgender men.

“Earlier studies suggested a higher risk of heart attack and stroke for transgender women compared to people with the same birth sex, that is, men from the general population,” said senior researcher Martin den Heijer, a professor of endocrinology at Amsterdam UMC.

“We did not really understand this. Now, however, we find no increased risk of heart and brain infarctions for transgender women who use estradiol," he added in a news release.

Researchers also found that transgender men had four times the heart attack risk and a 55% increased risk of stroke compared to cisgender women.

"We know that testosterone use in transgender men can lead to slightly higher blood pressure and poorer cholesterol levels, which increases the risk of cardiovascular disease,” van Zijverden said.

Overall, the results match the heart risks borne by cisgender men and women. Men generally have a higher risk of heart health problems than women, partially due to differences in sex organs, researchers said.

“These findings fit well with what we know about the presumed protective effects of estradiol on the heart and blood vessels,” den Heijer said. “With this research, we have solved a paradox that has occupied us for a long time.”

Researchers do suspect that factors other than hormone use also play a role in the increased heart health risk among transgender men.

“That is why we also looked at lifestyle and socio-economic factors in the study, such as education level, employment history and income,” van Zijverden said. “However, these factors were found to explain only a small part of the increased risk."

More research is needed into the exact causes of the increased risk in transgender men, as well as the lower risk in transgender women, researchers said.

More information

The Mayo Clinic has more on feminizing hormone therapy.

SOURCES: Amsterdam University Medical Center, news release, Nov. 4, 2025; European Heart Journal, Nov. 4, 2025