Venous Thromboembolism and Gender-Affirming Hormone Therapy: A Reappraisal of Risks and Benefits

Abstract

Transgender and gender-diverse individuals may require gender-affirming hormone therapy (GAHT) to achieve physical and mental changes consistent with their gender identity. 1 Coleman E. Radix A.E. Bouman W.P. et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022; 23: S1-S259 Crossref PubMed Google Scholar The incidence of thromboembolic events in the context of GAHT in transgender individuals seeking feminization has been reasonably well-studied. Estrogen treatment has been shown to cause procoagulant changes, leading to a state of hypercoagulability. Although prospective or controlled studies have not been conducted, retrospective studies have resulted in a better understanding of venous thromboembolism (VTE) during GAHT and in adjustments of GAHT that have reduced the number of VTE cases over time. 2 Irwig M.S. Cardiovascular health in transgender people. Rev Endocr Metab Disord. 2018; 19: 243-251 Crossref PubMed Scopus (52) Google Scholar As a consequence, the attitude toward assessing and addressing VTE risk during GAHT has shifted significantly. Once considered irreconcilable with GAHT, VTE is nowadays viewed as a manageable issue, as reviewed by Arrington-Sanders et al. 3 Arrington-Sanders R. Connell N.T. Coon D. et al. Assessing and addressing the risk of venous thromboembolism across the spectrum of gender affirming care: a review. Endocr Pract. 2022; (S1530-891X(22)00898-00899) Abstract Full Text Full Text PDF PubMed Google Scholar