Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy

Journal of Blood Medicine
Zil GoldsteinJoshua D Safer

Abstract

Introduction: Venous thromboembolism (VTE) is a potential risk of estrogen therapy. However, data show an improvement in the quality of life for transgender people who use feminizing hormone therapy. With few transgender-specific data, guidance may be drawn from cisgender (nontransgender) data, with a focus on hormonal birth control and postmenopausal hormone replacement therapy (HRT). The aim of this review is to examine the degree to which routes of administration, patient comorbidities, and type of hormone utilized affect the safety of estrogen therapy. Methods: We identified 6,349 studies by searching PubMed with the terms "transgender", "estrogen", "VTE", and "HRT". Of these, there were only 13 studies between 1989 and 2018 that investigated the effects of hormone therapy, including types of estrogens used, in transgender women and men. Results: The data suggest that the route of hormone administration, patient demographics, and patient comorbidities all affect estrogen's link with VTE. For example, avoiding ethinyl estradiol might make the use of hormone therapy in trans feminine individuals safer than oral birth control. Data from both cis and trans groups suggest additional VTE risk associated with the use of progestins...Continue Reading

Citations

Feb 16, 2021·The Journal of Clinical Investigation·Joshua D Safer
Mar 27, 2020·Clinical Biochemistry·Steven E Conklin, Claire E Knezevic
Mar 30, 2021·Plastic and Reconstructive Surgery·Rayisa HontscharukLoren Schechter
May 7, 2021·Andrology·Rayisa HontscharukLoren Schechter
Nov 27, 2020·Neuroendocrinology·Rosario PivonelloRobert P Millar

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Methods Mentioned

BETA
hormone replacement therapy
contraception
hysterectomy

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