Gender-affirming estrogen therapy route of administration and cardiovascular risk: a systematic review and narrative synthesis Academic Article uri icon

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  • This study is the first to summarize the potential effect of nonoral versus oral gender-affirming estrogen therapy use on cardiovascular risk factors in transgender women or nonbinary or gender-diverse individuals. Heterogeneity of studies in reporting gender-affirming estrogen therapy formulation, dose, and duration of exposure limits quantification of the effect of gender-affirming estrogen therapy on all-cause and cardiovascular mortality, adverse cardiovascular events, and cardiovascular risk factors. This systematic review highlights the needs for large prospective cohort studies with appropriate stratification of gender-affirming estrogen therapy by dose, formulation, administration route, and sufficient follow-up and analyses to limit selection bias to optimize the cardiovascular care of transgender, nonbinary, and gender-diverse individuals.


  • Turino Miranda, Keila
  • Kalenga, Cindy Z
  • Saad, Nathalie
  • Dumanski, Sandra M
  • Collister, David
  • Rytz, Chantal L
  • Lorenzetti, Diane L
  • Chang, Danica H
  • McClurg, Caitlin
  • Sola, Darlene Y
  • Ahmed, Sofia B

publication date

  • November 1, 2022