MON-LB040 Correlation Between Length of Hormone Therapy and Adverse Events in Transgender Veterans

Abstract

Objectives: We studied the transgender veteran population at a Veteran Affairs Medical Center (VAMC) retrospectively, regarding whether there is a correlation between length of hormone therapy, age and incidence of adverse events. Introduction: To date there is limited published data about long-term hormone therapy use in transgender individuals and specifically no published data for average age over 41 years. It is known from sex hormone-based studies in cis-gender individuals that long term use carries risks of adverse events including increased cardiovascular events, breast cancer, and thromboembolic events. Recent data does suggest that particularly with transgender women hormone replacement therapy increases risk of venous thromboembolism. Methods: We performed a retrospective chart review on any individual who identified by ICD 9 or 10 code with gender identity disorder, gender dysphoria, transgender female, or transgender male within the VAMC over the past 10 years. These charts were assessed for hormone therapy prescriptions specifically: estrogen, testosterone, spironolactone, or leuprolide, as well as history of such prescription. Clinic notes were reviewed regarding adverse events related to hormone therapy. Results: Eighty-seven patients were found with the ICD codes. Of those, 78 (89.7%) have previously been prescribed or are currently prescribed hormone therapy. Of all chart reviews, 8 (9.2%) suffered adverse events including venous thromboembolism, myocardial infarction, elevated hematocrit, elevated prolactin, and hyperkalemia. Of these adverse events 5 (5.7%) were secondary to estrogen, 2 (2.3%) were secondary to testosterone, and 1 (1.1%) was secondary to spironolactone. Interestingly, only 5 (5.7%) were symptomatic (venous thromboembolism, myocardial infarction, hyperkalemia) while 3 (3.4%) were asymptomatic (elevated hematocrit, elevated prolactin). The average age of adverse event was 57.7 years old and average time on hormone therapy until adverse event was 3.2 years. Five (62.5%) adverse events occurred at or before 3 years on hormone therapy and 2 of the 3 remaining adverse events that occurred after 3 years were asymptomatic as above. Conclusions: Among transgender patients at a VAMC 9.2% were identified as suffering an adverse event secondary to hormone therapy at an average at of 57.7 years old with an average length of time on hormone therapy to adverse event of 3.2 years. Despite our small sample size there appears to be a trend of symptomatic adverse events including venous thromboembolism, myocardial infarction, and hyperkalemia that occur at or before 3 years of hormone therapy.