HRT : Blood clots, bone and joint issues ? (long term consequences / more than 15 years therapy)
General Question
Eveoe
Hi
A lot of people are talking about HRT as an safe therapy : on the short term, sure, probably it is. But what about long term ? What about blood clots, bone and joint issues ?
(long term : more than 15 years)
Thank you, have a beautiful day !! <3
Andrea_Stars
The answer to this somewhat depends on whether you mean testosterone or estrogen HRT, and in both cases most data would have to be extrapolated from cis people and mixed with some understanding of the physiology.
Overall my take would be: Testosterone: Clotting risk - venous unchanged, arterial increased in line with cis men Bone - possibly improved bone density Joint issues - mostly unchanged, but maybe reduced risk of autoimmune arthritis, definitely reduced symptoms of pre-existing ligament dysfunction
Oestrogen Clotting risk - venous increased, but by what amount is debatable, probably small, arterial probably reduced, but possibly increased severity if they do happen Bone - possible slight reduction in bone density compared to cis men, increased density compared to post-menopausal cis women Joint issues - increase ligament laxity with associated increased flexibility and altered injury pattern in line with cis women. Possible worsening of pre-existing ligament issues. Possible increased risk of autoimmune arthritis in line with cis women.
SheSmilesBeatifical
20h ago
I agree with what you say about oestrogen. My life work involves being outdoors carrying a heavy pack, and since being on HRT, my upper body strength has changed dramatically. My ligaments have lengthened, and I have become very aware of the frailties of my own body. So I have adapted accordingly. I carry a lighter pack, and now practice gym training to maintain my core muscle strength. My flesh is no longer male, it is now female, my skeleton is light like a dancer, and I have always had to work at it to maintain my strength and fitness. At the age of 68 I recognise the compromises I have to make in order to be female, and I accept that.
Andrea_Stars
19h ago
There is a much bigger difference in upper body strength between men & women than in lower. How much of that is true when we're talking about trans people isn't well understood because (surprise surprise) very few studies have been done.
SheSmilesBeatifical
19h ago
There has been very little research being done about cross-hormone therapy at all. Most of it is anecdotal, and even that is like walking on a quicksand of hearsay. I am thankful for having an analytical mind … but yes, upper body strength - mine was quite considerable before starting HRT. Small pigeon chest, narrow hips, long legs, and the fall-off of upper body muscle mass was considerable. My upper arms developed fat deposits, my dad pod became a mum pod, my hips, thighs, and calves grew thicker. I let it all happen. My pelvis began to tilt, and I developed lower back pain. At 36 months, I knew that I was ready to start gym training again to pull everything back into shape as a woman’s body - not a man’s, and 7 months later it has turned out well doing three hours of low impact endurance training three times a week. That’s using walking, cycling and rowing machines combined with yoga and lifting small hand weights. Everything is now working properly, I have a waist, a bottom, thighs, and everything is toning up. It’s not like I read a hardback book and said “oh yes, I will do that”, more like figuring everything out in the dark before leaping into the light.
I trust that the OP appreciates where I am coming from on all of this.
Eveoe
18h ago
Thank you for these feedback !
I also have fears regarding muscular strength : I am not very muscular and tend to get tendinitis easily ... however, my doctor told me that there was no risk of doing more easily develops tendinitis in the event of loss of muscular strength (but, on the other hand, he doesn't know much about HRT ... )
SheSmilesBeatifical
14h ago
Last reply:- if you exercise more you will become stronger. Tendinitis is a form of repetitive strain injury, and can be easily avoided by varying your range of movements through different exercise routines. HRT has very little to do with it.
SheSmilesBeatifical
22h ago
Have you done your research? Your question(s) are somewhat vague, so my reactive response is to say ‘SHED’ - sleep, hydration, exercise and diet. Whether on hormone therapy or not, satisfaction of all four is a prerequisite to a long and healthy life
Eveoe
22h ago
Hello ! I've read a lot on the subject, yes. These problems are often referred to as a "risk".
Furthermore, I have the impression that on the forum, many people have been on hrt for less than 10/15 years (a lot for some years only) : apart from that, I wonder about the real effects, really perceived (real life) by people who have been on hrt for a very long time.
ExternalSort8777
17h ago
These problems are often referred to as a "risk".
But that's what you are asking about. The risks associated with long term HRT.
on the forum, many people have been on hrt for less than 10/15 years (a lot for some years only
which makes this a weird place to be asking for anecdotes about long-term negative outcomes or deleterious side effects -- even if the stories you read here were trustworthy (they are not) or meaningful.
What would you conclude, if somebody were to respond to this question by claiming that they'd started HRT at 36, are now 51
and that contra-sexual hormones gave them "joint issues"?
I've read a lot on the subject, yes
What have you read? Where are you looking?
Are you comfortable with statistics? Do you know what p-values mean? z scores? Would you be confident interpreting numbers presented with confidence intervals?
Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals
Gender-affirming care and endocrine-related cancers (Review)
Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy
Long term hormonal treatment for transgender people
Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria
Eveoe
17h ago
Let's say I make do with what I have : and ultimately, that's why I asked this question here ! And finally I did well to ask this question because - and I thank you very much ! - you have just provided me with lots of constructive reading ! Thanks again !
ExternalSort8777
17h ago
Let's say I make do with what I have
No idea what that is supposed to mean.
I did well to ask this question because - and I thank you very much ! - you have just provided me with lots of constructive reading !
https://scholar.google.com/
https://www.sciencedirect.com/
https://pubmed.ncbi.nlm.nih.gov/
and SciHub for stuff behind a paywall
https://sci-hubtw.hkvisa.net/

•
22h ago
If that is so, then why are you asking these questions here?
Bye_me_hi_me
22h ago
Because experience from real people is different from stats? Because not all research is segmented by age groups? Because others may have done more research and be able to point others in the right direction?
Eveoe
]22h ago
Because I am 36 years old and I want to know what the real risks are for people who started their transition late

Biologically this may make a difference compared to people who transitioned as adolescents.
SheSmilesBeatifical
21h ago
OK, now we are getting somewhere. Those who transition young, say under the age of 27, are producing human growth hormone (HGH) in copious amounts, and will transition more quickly and effectively than those who are over the age of 40. After 35, the body produces progressively smaller and smaller amounts of HGH - that is:- unless the body gets physical exercise and increases it’s production of HGH. This is why lifelong bodybuilders can reach the age of 70 and have the body of a 30 year old - true for both cis and trans gender men and women.
It has been proven over and over again that both MtF and FtM late in life transitioners who are in good health will benefit immensely from HRT - so long as they are in relatively good health before they start, and so long as they continue to remain in good health. This is why I put the emphasis on SHED. HRT changes the entire cellular structure of the body, including all tissues, organs, skeleton and the brain, with corresponding effects to the mind and personality, and will continue to do so for the rest of your life. SHED is the key to long term trans gender health care. So long as the transitioner is aware of the significance of SHED and practice self-care, their body will continue to produce HGH and they will transition effectively.
By my own example, I am 68 years of age, have always been extremely fit and healthy, and been on HRT for 43 months. My body has changed considerably in this time frame, and will continue to do so until I reach the age of 72. By then I will have been on HRT for 7 years - the time that it takes the human body to completely regenerate itself on a cellular level. By the age of 70, I - will - have the body of a 30 year old, and the last laugh will be mine. The secret is getting enough exercise to stimulate the body into a state of constant regeneration.
So, if you are on HRT, or thinking of starting HRT, be assured you will not come to any long term harm, and just go for it.
Eveoe
18h ago
Thank you for that answer !
I am indeed considering starting hrt : however, I would not like the benefits to be outweighed by possible significant physical risks as I age (particularly related to the joints/bones), not having any real physical dysphoria (It would be more about realigning a body with a gender/a sense of belonging).
The paragraph about HRH is very interesting, I didn't have this knowledge, thank you !
ExternalSort8777
17h ago
So, you want to know what your risks are at 51 -- if you start HRT at 36 -- compared to a person who started HRT as an adolescent?
You want to know if you will be as healthy in your fifties as someone who started HRT 33 years ago -- in 1991? (assuming you mean a person who did not go on blockers as a younger adolescent, and who started HRT at 1

.
Eveoe
17h ago
Hi

I am trying to find out if hrt started late can increase certain health risks/discomfort in a significant or recurring manner (e.g. 20 years of hrt for a person who started at 35/40 years old)
ExternalSort8777
17h ago
You are asking in the wrong place. Not just because this sub is mostly for and by people who's "egg cracked" after they turned 30,
Reddit's upvote/downvote system and batsh!t "karma" points are a perverse incentive. People will re-post "what everybody knows" for points -- despite (or, sometimes because) -- the thing that "everybody knows" being easily refuted.
Eveoe
1h ago
People really care about points ??????
joym08
14h ago
I've been on HRT estradiol for 19 years other than soft skin, fat redistribution and muscle mass loss. I have no blood clots, my bones are fine. I can say that because my recent DEXA scan was good.
Babeliciousness
14h ago
Still safe. I started with 3 other girls at the same time back in 1990, I had to detransition 9 months in, but 1 of those ladies and I are still in touch. She's fine. She's been cheering me on as I am now 16 months on hormones Finally doing what she's been doing all these years living authentically.
You do your bloodwork and you live life.
ughineedtopostaphoto
16h ago
Those are all the same risks most cis women accept as part of birth control. Yet millions of cis women are on birth control and we regard it as safe and recommend people put their children on it post puberty to make sure they don’t have a pregnancy.
Some this is about harm reduction and each individuals risk profile. If you are perfectly fine and happy in your body and you will make it the next 20 years happily without it and have a family history that says those things are likely to happen, maybe you choose not to. That doesn’t make you any less trans to not have HRT. But also if you’re going to be miserable and in and out of the mental health hospital and hate your body and your life for those 15 years…you don’t have to live that way. You have an option.
I think also this has the sound to me of someone who has maybe gotten information from anti transition folks or detrans folks or from transphobic folks, or maybe just run of the mill western medical fears. I really encourage you to consider your sources and who the intended audience is.
l2blackbelt/
6h ago
Just because two things elevate the chances of similar things does not make them equal. If you check out
u/extrrnalsort887's comment, the ratio of death in the Amsterdam Cohort due to cardiovascular event for transwomen over the span of 50 years was 8:1 compared to cis men, and 5:1 for cis women.
While some attribute these numbers to the older generation of HRT the Amsterdam cohort was provided, similar mortality numbers were reported in the 2019 sample
Cardiovascular Outcomes In Gender Dysphoric Patients Undergoing Hormone Replacement Therapy (Ahmed, 2023).
Suffice to say the cardiac risk for HRT is substantially higher than birth control.
Eveoe
1h ago
I think I will be able to live the next 20 years without hrt ... But it would perhaps remain a regret not to have started : until proven otherwise you only live once !! So there is perhaps a dimension here linked to wisdom : grieving, accepting being a man and not being born a woman ...
Regarding heart risks, this is a mortal risk : as I write these lines, death is not really what I fear ; what I fear are disabling dysfunctions (fragile joints, bones, etc.).
Thanks for all the details !
l2blackbelt
11h ago
We know that MTF HRT impacts the heart in the long term. The science is out on how much. HRT increases the lifetime risk of several life-threatening heart issues, (myocardial infarction, ischemic stroke, STEMI), as well as neoplasm (benign and melignant tumor growth) from anywhere to 2x to 7x, depending on the study.
MudOk790
8h ago
Driving a car is a risk. Crossing the street is a risk. Smoking anything is a risk. Under proper medical supervision your risk is minimal. Now DIY can be risky. Not having blood levels checked. I've done research on estrogen levels during pregnancy. They can spike to over 1,000. Our levels generally didn't go that high. So what's riskier? Being MTF or being pregnant? My Endo prefers I stay around 200. Pretty huge difference.
Seattlantiss
18h ago
Roughly the same effects as cis people having normal hormone levels for 15+ years. These days, the hormones used for HRT are bio identical to endogenously produced hormones.
This post is giving some extremely suspicious energy to be frank. It seems like you’re probably a troll or a debate bro, and neither of those are allowed on this subreddit.
Eveoe
18h ago
Frankness and the truth are not always sexy : but that's what I'm looking for
I'm one of the slightly strange people (at least I see myself that way) who are not depressed/suicidal and who don't have any problem with their body : if I start hrt I do not want to have to pay heavy physical consequences in 20 years which could outweigh the benefits ... (the benefits being : having a feminine body which I would like/which would allow me a better alignment with my gender, which would allow me to be perceived a little more easily as a woman and a psychological change in my way of understanding my environment and my life).
However, all this is still at the thought stage...