Nutrition and Heart Health for Transgender People on Hormone Therapy

Transgender people have a gender identity and/or expression that differs from their sex assigned at birth. Some transgender people may use hormone therapy to produce physical changes that help align their body with their gender identity. Estrogen-based hormone therapy involves blocking testosterone production and using estrogen; testosterone-based therapy involves taking testosterone.

Hormone therapy and heart health

Hormone therapy causes physical changes, such as shifts in body size, fat mass, muscle mass and body shape. Changes in hair growth, skin oiliness and the sound of one’s voice also are common.

Additionally, hormone therapy may impact lab values and tests used to measure heart health. These include total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and blood pressure.

As a result, one’s risk for heart disease may change. Testosterone-based hormone therapy may increase the risk of coronary artery disease, cerebrovascular disease or hypertension. Estrogen-based hormone therapy may increase the risk for blood clotting, coronary artery disease or cerebrovascular disease.

Nutrition considerations

Nutrition can be a helpful tool to improve heart health and decrease disease risk, especially for those undergoing hormone therapy. The 2020-2025 Dietary Guidelines for Americans, Dietary Approaches to Stop Hypertension (DASH Eating Plan), or the Mediterranean diet are sound eating patterns to promote heart health.

In general, a heart-healthy diet includes:

• A variety of differently colored fruits and vegetables
• Whole grains such as oats, brown rice and whole wheat
• Lean protein, which may include animal-based sources (fish, poultry and meat) and plant-based sources (beans, legumes, tofu, nuts, seeds)
• Unsaturated fats, such as plant-based oils, avocados, nuts and seeds
• Dairy foods or plant-based dairy alternatives

A heart-healthy diet is low in:

• Sodium
• Saturated fat
• Added sugars

Lastly, a heart-healthy diet includes moderate (up to one or two drinks per day) or no alcohol intake. Individuals who don’t drink are not recommended to start.

Physical activity guidance

Regular physical activity is another important way to support heart health. The Physical Activity Guidelines for Americans recommend either a minimum of 150 minutes of moderate-intensity physical activity per week (such as brisk walking), 75 minutes of vigorous-intensity activity (such as jogging) or a combination of the two. The guidelines also recommend two days of muscle-strengthening activities per week.

As an added bonus, physical activity is good for mental health as well. Find enjoyable activities to do and be physically active with friends or family to keep moving.

How an RDN can help

For those undergoing hormone therapy, a registered dietitian nutritionist can help plan a healthy eating pattern that supports heart health and meets nutrition goals. To find a local RDN, use the Find a Nutrition Expert tool. This database has search filters for in-person or telehealth services and RDNs with various specialties such as heart health, healthy eating and wellness, or weight management, among others.