Citation
Arrington-Sanders, Renata; Connell, Nathan T.; Coon, Devin; Dowshen, Nadia L.; Goldman, Anna L.; Goldstein, Zil; Grimstad, Frances; Javier, Noelle M.; Kim, Ellie; & Murphy, Martina, et al. (2023). Assessing and Addressing the Risk of Venous Thromboembolism across the Spectrum of Gender Affirming Care: A Review. Endocrine Practice, 29(4), 272-278. PMCID: PMC10081942Abstract
OBJECTIVE: Accumulating evidence demonstrates that gender affirming hormone therapy improves mental health outcomes in transgender persons. Data specific to the risks associated with gender affirming hormone therapy for transgender persons continue to emerge, allowing for improvements in understanding, predicting, and mitigating adverse outcomes while informing discussion about desired effects. Of particular concern is the risk of venous thromboembolism in the context of both longitudinal gender affirming hormone therapy and the perioperative setting. Combining what is known about the risk of VTE in cisgender individuals on hormone therapy with the evidence for transgender persons receiving hormone therapy allows for an informed approach to assess underlying risk and improve care in the transgender community.OBSERVATIONS: Hormone formulation, dosing, route, and duration of therapy can impact thromboembolic risk, with transdermal estrogen formulations having the lowest risk. There are no existing risk scores for venous thromboembolism that consider hormone therapy as a possible risk factor. Risk assessment for recurrent venous thromboembolism and bleeding tendencies using current scores may be helpful when assessing individual risk. Gender affirming surgeries present unique perioperative concerns, and certain procedures include a high likelihood that patients will be on exogenous estrogens at the time of surgery, potentially increasing thromboembolic risk.
CONCLUSIONS AND RELEVANCE: Withholding gender affirming hormone therapy due to potential adverse events may cause negative impacts for individual patients. Providers should be knowledgeable about the management of hormone therapy in transgender individuals of all ages, as well as in the perioperative setting, to avoid periods in which transgender individuals are off gender affirming hormone therapy. Treatment decisions for both anticoagulation and hormone therapy should be individualized and tailored to patients' overall goals and desired outcomes, given that the physical and mental health benefits of gender affirming care may outweigh the risk of venous thromboembolism.
URL
http://dx.doi.org/10.1016/j.eprac.2022.12.008Reference Type
Journal ArticleYear Published
2023Journal Title
Endocrine PracticeAuthor(s)
Arrington-Sanders, RenataConnell, Nathan T.
Coon, Devin
Dowshen, Nadia L.
Goldman, Anna L.
Goldstein, Zil
Grimstad, Frances
Javier, Noelle M.
Kim, Ellie
Murphy, Martina
Poteat, Tonia
Radix, Asa
Schwartz, Aviva
St. Amand, Colt
Streed, Carl G. Jr.
Tangpricha, Vin
Toribio, Mabel
Goldstein, Robert H.