Cardiac Troponin I & Gender Affirming Hormone Therapy

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Hormone Therapy Alters Heart Biomarkers in Transgender Adults, Study Finds

A new study reveals that gender-affirming hormone therapy (GAHT) considerably shifts levels of a key heart biomarker, Cardiac Troponin I, in transgender adults, aligning them more closely with their affirmed gender. The findings, published in October 2025 in JAMA Network Open, have important implications for cardiovascular risk assessment in this population.

A critical challenge in transgender healthcare has been determining appropriate cardiovascular risk markers. Cardiac troponin I, a protein released when the heart muscle is damaged, is a standard measure of cardiac injury and predictor of cardiovascular events.Current medical guidelines utilize sex-specific reference ranges for this biomarker, recognizing that men generally have higher levels due to greater muscle mass. however, until now, it remained unclear which ranges should be applied to transgender individuals undergoing hormone therapy.

Did you know? – Cardiac Troponin I is released when the heart muscle is damaged and is used to assess cardiac injury and predict cardiovascular events.

Tracking Biomarkers During Transition

To address this gap in knowledge, researchers in Australia conducted a prospective study following 152 adults – both transgender and cisgender individuals – over a 12-month period. The study meticulously assessed Cardiac Troponin I levels alongside measurements of testosterone and oestradiol. This longitudinal approach, tracking changes over time, provides stronger evidence than previous cross-sectional studies.

Pro tip: – After 12 months of gender-affirming hormone therapy, clinicians should use affirmed gender reference ranges when interpreting Cardiac Troponin I levels.

Hormone-Driven Shifts in Cardiac Troponin I

The results demonstrated clear correlations between hormone levels and Cardiac Troponin I. In transgender women, the study observed a marked increase in oestradiol coupled with a significant decrease in testosterone. This hormonal shift was accompanied by a decrease in Cardiac Troponin I levels,bringing them closer to those typically seen in cisgender women (ratio of geometric means = 2.24; P = 0.21) and significantly lower than cisgender men (RGM = 0.22; P = 0.01).

Conversely, transgender men experienced increased testosterone and decreased oestradiol. Consequently, their Cardiac Troponin I levels moved toward cisgender male ranges (RGM = 0.56; P = 0.32), though they remained notably higher than those of cisgender women (RGM = 7.39; P = 0.003).

“These results suggest that Cardiac Troponin I levels evolve with gender-affirming therapy,” one researcher stated, “potentially linked to changes in cardiac mass or ventricular function.”

Reader question: – Why is it critically important to use sex-specific reference ranges for Cardiac Troponin I? Men generally have higher levels due to greater muscle mass.

Implications for Clinical Practice

The study’s findings strongly support the use of affirmed gender reference ranges when interpreting Cardiac Troponin I levels in transgender patients after 12 months of GAHT. Clinicians should be aware of these biomarker patterns when evaluating cardiac risk or diagnosing potential heart injury.

The researchers emphasize the need for further investigation. Future studies incorporating cardiac imaging and longer-term follow-up are crucial to fully understand the structural mechanisms driving these shifts and to refine cardiovascular monitoring practices for transgender individuals. This research builds upon existing knowledge and provides vital evidence for personalized healthcare approaches.

Reference: Cheung AS et al. High-sensitivity cardiac tro