About the author:
Katelyn Jackson is a member of the Foundation to Advance Vascular Cures team and identifies as queer. She is passionate about the foundation’s commitment to better vascular health for all people.

Communicating with healthcare professionals can be difficult for anyone, but for queer/trans people, it can be even more challenging to navigate how to come out to our healthcare team. Many LGBTQ+ people have stories about awkward interactions in healthcare, from lesbians reassuring doctors that they’re definitely not getting pregnant, to gay dads having to explain the connection to their children. No matter how you choose to discuss your identity with your physicians, here are a few concerns to bring up with your providers regarding your vascular health.

Higher Risk of Stroke and Blood Clots for Trans Women on Estrogen

A recent study found that transgender women taking estrogen for gender affirmation had a higher risk of stroke and blood clots than nontransgender women and nontransgender men. The highest risk differences were found several years after starting estrogen. 

Questions to ask your doctor:

• What can I do to reduce my blood clot risk while I’m on estrogen?

Increased Incidence of PCOS for Queer Cis Women

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens. The name polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form in the ovaries. Some of the symptoms of PCOS are missed periods, excess body hair, and weight gain around the abdomen. A 2004 study found that lesbians were about two and a half times more likely to have polycystic ovary syndrome. About 80% of lesbians had polycystic ovaries.

Vascular health concerns:
According to Johns Hopkins Medicine, several of the risk factors for PCOS are those which also increase risk of vascular diseases or incidents. (Source)

For instance, carrying excess weight, having higher-than-normal blood pressure, and being diabetic all affect your vascular system and can exacerbate issues. These are all risk factors or effects of PCOS. In fact, the associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease says, "Studies suggest that women with PCOS have a twice as likely risk of a future cardiovascular event, like a heart attack or stroke." (Source)

Questions to ask your doctor:

• I’m at an increased risk for PCOS. Is there anything we should do to screen me for PCOS?

• Are there risk factors that I currently have for PCOS and cardiovascular diseases/events that we can address?

Increased Blood Clot Risk for Trans Men on Testosterone

Transgender men often undergo testosterone therapy as part of their gender-affirming treatment. Erythrocytosis, a condition where your body makes too many red blood cells, is a common side effect of testosterone therapy that can increase the risk of blood clots, heart attack, or stroke. (Source)

Questions to ask your doctor:

• Am I being monitored for erythrocytosis?

• Should I switch from injectable testosterone to gel testosterone to reduce my risk of blood clots?

Higher Risk of Stroke for LGBTQ+ People

A UCSF study released in 2023 found people who identify as LGBTQ+ may have a higher risk for stroke at a younger age, as well as a possible higher risk for recurrence than those who identify as straight and cisgender, according to a small study in San Francisco. While stroke subtypes and traditional stroke risks, such as smoking, hypertension and diabetes, were similar for both groups, the sexual and gender minority patients were more likely to have “non-traditional stroke risks.” These risks included HIV and current or previous history of syphilis and hepatitis C, conditions that can increase stroke risk as a result of inflammation and blockage of blood vessels.

Dr. Nicole Rosendale, the lead researcher on the study explains that “future research will need to explore the drivers of recurrent stroke, including the role of minority stress. Stigma, prejudice and discrimination create an inherently stressful environment that translates into health issues.”

Questions to ask your doctor:

• Is there anything I can do to manage my risk of stroke?

Self-Care is a Radical Act

If you do a deep dive into the research on queer/trans people and our health concerns, you might find a common narrative: LGBTQ+ people are more at-risk for health concerns because we’re more likely to smoke, carry excess weight, or drink alcohol. Flipping the narrative to focus on stressors encountered by queer/trans people might help: as LGBTQ+ people, we face increased stressors than our straight/cisgender peers, and self-care is a radical act to address the increased stressors.

Try some of these self-care strategies as an act of warfare:

While LGBTQ+ people may face increased vascular health risks, we can address them head-on by speaking up at the doctor's office and practicing radical self-care.