Assess cardiovascular risk factors in persons on hormone therapy
STEP 1 — Gather Information
Collect fasting lipid profile (total cholesterol, LDL, HDL, triglycerides), fasting glucose or HbA1c, blood pressure, smoking status, and family history of premature CVD.
→ Proceed to assess lipid and glucose results.
STEP 2 — Rule In / Rule Out
Rule in increased cardiovascular risk if LDL ≥130 mg/dL, triglycerides ≥150 mg/dL, HDL <40 mg/dL (men) or <50 mg/dL (women), fasting glucose ≥100 mg/dL, or HbA1c ≥5.7%; otherwise rule out increased risk.
→ If any abnormality present, classify risk; if none, classify as low risk.
STEP 3 — Classify or Stratify
Stratify risk: low (0 abnormalities), moderate (1 abnormality), high (≥2 abnormalities).
→ Determine management intensity based on stratum.
STEP 4 — Decide
Low risk: repeat assessment in 12–24 months; moderate risk: initiate lifestyle modification and repeat lipids/glucose in 6–12 months; high risk: consider statin or glucose-lowering therapy per guidelines and refer for aggressive risk factor management.
→ Implement tailored intervention plan.
Clinical Guardrails / Mimics / Pitfalls
Do not rely on non-fasting lipids; do not overlook blood pressure or smoking; avoid assuming hormone therapy negates CVD risk; do not delay screening in patients >40 years or with additional risk factors; remember to evaluate for secondary causes of dyslipidemia (e.g., hypothyroidism).
Concrete Clinical Example
A 24-year-old transgender man on testosterone therapy presents for routine visit. Fasting lipids: LDL 135 mg/dL, triglycerides 160 mg/dL, HDL 38 mg/dL; fasting glucose 95 mg/dL. Two lipid abnormalities (LDL high, triglycerides high) and low HDL → high risk → start lifestyle counseling, discuss statin option, and recheck lipids in 3 months.
Source: Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2017, DOI:10.1210/jc.2017-01658