American Heart Association: Transgenders Face Differing Health Challenges

The American Heart Association, supported by volunteers, fund research, advocate for publics health and share resources. The Dallas-based organization has been a source of health information for nearly a century. They have asked Frank Report to publish this article to draw attention to health care disparities for Transgender Day of Remembrance.

With Transgender Day of Remembrance on November 20, 2021, the American Heart Association, is drawing attention to unique factors affecting transgender health and calling for swift policy action to address health care disparities and equitable access to care for transgender people.

In a new scientific statement released in July 2021, the Association found that there are higher levels of heart disease among transgender and gender diverse people which are linked to the stress of experiencing discrimination and transphobia at personal and societal levels. Poorer health outcomes are also linked to lack of equitable access to care and higher levels of smoking and overweight or obesity.

“Heart disease and stroke do not discriminate,” said Carl Streed Jr., M.D., M.P.H., chair of the writing group for the statement, an assistant professor of internal medicine at Boston University School of Medicine and the research lead at the Center for Transgender Medicine and Surgery at Boston Medical Center. “This is why we are highlighting the critical science and calling for further action in addressing disparities in health equity for transgender and gender diverse people. There is a need for additional training for clinicians and health care professionals to ensure gender diverse and transgender people feel safe and welcome in the health care setting. Training is also needed to make sure there is appropriate screening and management of cardiovascular issues and risk factors, particularly those associated with discrimination and stress, that are more prevalent in LGBTQ+ communities, such as smoking and excess alcohol consumption.”

The American Heart Association, the world’s leading nonprofit organization focused on heart and brain health for all, is tracking how heart disease uniquely affects the LBGTQ+ population and this most recent science builds upon the Association’s 2020 scientific statement, Assessing and Addressing Cardiovascular Health in Lesbian, Gay, Bisexual, Transgender and Queer (or Questioning) Adults. That statement notes that more than half (56%) of LGBTQ adults and 70% of those who are transgender, or gender non-conforming reported experiencing some form of discrimination from a health care professional.

According to the American Heart Association’s scientific statements, LGBTQ+ individuals, and particularly people who are transgender and gender diverse, may be at a significantly greater risk for adverse cardiovascular outcomes when compared to cisgender individuals.

Transgender and gender diverse populations also face unique psychological stressors, including gender non-affirmation (e.g., being called by the incorrect pronoun), discrimination, rejection or concealment of gender identity and violence based on gender identity. These factors contribute to higher overall levels of stress, which, in turn, negatively affect heart health. Additionally, transgender and gender diverse people who are also part of historically excluded racial or ethnic groups experience multiple layers of stress, such as lower income levels or limited access to health care. Research on how these complex and intertwined factors affect heart health within this community is limited.

Facts on transgender people and cardiovascular health:

• Transgender men are twice as likely to have a heart attack than cisgender men and four times as likely than cisgender women.
• Transgender people and individuals who are gender diverse are also more likely to experience blood clots when undergoing estrogen hormone therapy. The writing group points out more investigation is urgently needed to explain these disparities.
• People undergoing gender-affirming hormone therapy are more physically active, which may be because they report being more satisfied with their bodies.
• Transgender and gender diverse youth report eating more fast food and using unsafe ways of trying to manage their weight (e.g., diet pills, fasting or laxative abuse).
•  People in this community report overall higher body mass index (BMI), yet they may experience additional stress about their weight since many surgeons have strict BMI cut-offs above which they will not perform gender-affirming surgeries.

What can be done to improve health for LGBTQ+ people?

• Add LGBTQ+-related content to health care professional training and licensure requirements.
  • The Accreditation Review Commission on Education for the Physician Assistant began requiring LGBT curricular content in September 2020.
• Include sexual orientation and gender identity information in electronic health records to provide:
  • an opportunity to address specific health concerns for LGBT patients, and
  • information that allows broader examination in research and public health efforts of the cardiovascular health of LGBT adults.

Guest View