Fortunately, much of that can be mitigated by choosing estradiol patches or injections instead of pills so you can use a lower dose and put less strain on your kidneys. And recent findings that anti-androgens really aren't needed for most people means less strain on organs. Estradoil alone will usually trigger the body to produce less testosterone naturally.

But yes, people with existing conditions can be negatively affected. But often are just as negatively affected by their own testosterone in those cases.

Problem is that drug companies don't make the hormones for trans people and have generally refused to do research about using them for that purpose, but are perfectly happy to sell them for that purpose, because profit. So doctors have had to learn much more slowly.