Gender-affirming care in adolescents and young adults with cardiovascular conditions: clinical considerations in a limited evidence landscape.

Gender-affirming care is a multi-faceted healthcare provided to transgender and gender diverse individuals to support their physical and mental health. As more adolescents and young adults may be interested in various gender care options, cardiologists should have familiarity with the medical and surgical therapies offered and the risk and considerations these may have, particularly for youth with the history of congenital or acquired cardiovascular disease. The existing literature on exogenous hormone therapy, for the general population and transgender individuals specifically, is by large limited to the adult population, with little relevant information for younger individuals. Current evidence indicates several potential cardiovascular implications to consider with gender-affirming hormone therapy without documented morbidity or clear contraindication for its use. These include the risk of thromboembolism, atherosclerotic and coronary artery disease, hypertension, and dyslipidemia among others. This review summarises existing evidence to assist in navigating the risks and therapeutic options so that offering gender-affirming care can be considered and delivered safely for adolescents and young adults with cardiovascular conditions and makes recommendations for future research.