Brazilian social media influencer Maya Massafera has been cleared of a stroke after being hospitalized on Sunday, August 30, following concerns raised by her medical team over severely elevated cholesterol levels.
The 45-year-old fashion stylist and television personality addressed her followers on Instagram to explain that her physician requested urgent diagnostic imaging to rule out a stroke. Subsequent testing confirmed that no stroke had occurred.
Massafera stated that she had recently modified her hormone therapy regimen and that her cholesterol levels had already shown signs of improvement. She added that she shared the update to reassure her audience ahead of her upcoming reality show appearance.
Hospitalization and medical testing
A stroke, or cerebrovascular accident, occurs when blood flow to a portion of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and essential nutrients. Ischemic strokes, which account for the majority of cases, develop when a blood vessel supplying the brain becomes obstructed by a clot or fatty deposit.
In response to Massafera's hospitalization, medical experts emphasized that while elevated cholesterol is a recognized cardiovascular risk factor, high lipid levels alone do not diagnose a stroke. A definitive stroke diagnosis requires a thorough evaluation of acute neurological symptoms, physical examinations, and neuroimaging scans such as computed tomography or magnetic resonance imaging.
Endocrinologist Dr. Wandyk Alisson noted that Massafera's experience does not demonstrate that hormone therapy caused a stroke, particularly since the condition was ruled out by her physicians. He added that existing medical data does not support identifying hormone treatment as the sole trigger for her altered cholesterol levels.
Hormone therapy and cardiovascular risk
Gender-affirming hormone therapy for transgender women typically involves estrogen formulations, such as estradiol, often combined with androgen blockers to suppress testosterone. These therapies assist individuals in aligning their physical characteristics with their gender identity.
Dr. Alisson explained that hormone treatments used during gender transition can be associated with an increased risk of stroke, particularly ischemic stroke caused by arterial blockages. However, he stressed that it is inaccurate to claim that hormone therapy inevitably causes strokes or that all hormone types, dosages, and administration routes present equal risk.
According to Dr. Alisson, oral estradiol, especially when administered in elevated doses or above physiological ranges, can stimulate the liver to produce higher levels of blood clotting factors. He noted that scientific studies most consistently document a heightened risk of venous thrombosis, which involves blood clots in deep veins, and pulmonary embolism, where clots travel to the lungs. In contrast, the direct relationship between hormone therapy and arterial strokes remains less conclusive.
Dr. Alisson cited a 2024 meta-analysis that recorded a stroke incidence of approximately 1.8 percent among transgender women and 0.8 percent among transgender men. This data reflects a relative stroke risk roughly 30 percent higher than that observed in cisgender individuals of the same birth-assigned sex.
Understanding lipid markers and stroke diagnosis
Addressing the relationship between blood lipids and cardiovascular health, Dr. Alisson stated that high cholesterol must not be treated as a single uniform figure. Proper medical evaluation requires identifying which specific lipid particles are elevated and understanding the underlying biological mechanisms.
Cardiovascular risk assessment involves examining several distinct markers, including low-density lipoprotein (LDL), triglycerides, non-HDL cholesterol, apolipoprotein B, and lipoprotein(a). LDL cholesterol and apolipoprotein B contribute directly to the formation of arterial plaques, which can constrict blood vessels over time.
Lipoprotein(a) levels are predominantly determined by genetics and can elevate cardiovascular risk even in individuals who maintain balanced diets and engage in regular physical exercise. Dr. Alisson observed that while oral estradiol can lower LDL levels in some patients, its metabolism in the liver can simultaneously raise triglyceride concentrations.
Preventive care and lifestyle management
To minimize cardiovascular risks associated with gender-affirming care, Dr. Alisson recommended comprehensive individual health evaluations prior to starting hormone therapy. Physicians should screen patients for high blood pressure, diabetes, pre-existing high cholesterol, tobacco use, migraine with aura, sleep apnea, liver or kidney disease, past thrombosis or stroke, and family history of early cardiovascular events.
Dr. Alisson emphasized that gender-affirming hormone therapy should not be demonized or abruptly discontinued without medical guidance. He stated that the treatment must be managed like any long-term medical intervention, incorporating clear clinical indications, personalized dosing, continuous monitoring, and active management of cardiovascular risk factors.
Neurologist Dr. Carolina Alvarez affirmed that adopting a healthy lifestyle represents the primary defense against strokes. She highlighted that habits such as avoiding smoking, exercising regularly, eating a balanced diet, and controlling blood pressure, diabetes, and cholesterol levels significantly lower overall cardiovascular risk.
Dr. Alvarez added that a potential increase in stroke risk does not mean patients should avoid hormone therapy. She stated that with individualized assessments and proper clinical oversight, healthcare providers can determine the most appropriate hormone type, dosage, and delivery method for each patient.
