Introduction One of the most serious known adverse effects of feminizing cross-sex hormone therapy (CSHT) is venous thromboembolism (VTE); however, no study has assessed the incidence of VTE from the hormone therapies used in the United States because previous publications on this topic have originated in Europe. CSHT in the United States typically includes estradiol with the antiandrogen spironolactone, whereas in Europe estradiol is prescribed with the progestin cyproterone acetate. Aim To estimate the incidence of VTE from the standard feminizing CSHTs used in the United States. Methods A retrospective chart review of transgender women who had been prescribed oral estradiol at a District of Columbia community health center was performed. Main Outcome Measure The primary outcomes of interest were deep vein thrombosis or pulmonary emboli. Results From January 1, 2008 through March 31, 2016, 676 transgender women received oral estradiol-based CSHT for a total of 1,286 years of hormone treatment and a mean of 1.9 years of CSHT per patient. Only one individual, or 0.15% of the population, sustained a VTE, for an incidence of 7.8 events per 10,000 person-years. Conclusion There was a low incidence of VTE in this population of transgender women receiving oral estradiol.

Gender-diverse people likely suffer from higher rates of cardiovascular disease than cisgender people. Studies on the effects of gender-affirming hormone therapy (GAHT) on blood pressure in adult transgender populations have been inconsistent. We sought to address knowledge gaps on this topic by conducting the largest and longest observational study to date using multiple blood pressure readings from a racially and ethnically diverse sample. We followed the blood pressure of 470 transgender and gender-diverse adult patients (247 transfeminine and 223 transmasculine; mean age, 27.8 years) seen at a Federally Qualified Health Center and an academic endocrinology practice, both in Washington DC. Blood pressure was measured at baseline and at multiple follow-up clinical visits up to 57 months after the initiation of GAHT. Our study found that within 2 to 4 months of starting GAHT, mean systolic blood pressure was lower in the trans feminine group by 4.0 mm Hg ( P <0.0001) and higher in the trans masculine group by 2.6 mm Hg ( P =0.02). These blood pressure changes were maintained during the whole follow-up period. There were no changes to diastolic blood pressure for either group. The prevalence of stage 2 hypertension decreased in the trans feminine group by 47% ( P =0.001) within 2 to 4 months of GAHT. In conclusion, our data support routine blood pressure monitoring after the initiation of GAHT. Further research is needed on the effects of GAHT in older gender-diverse individuals and on optimal formulations of GAHT.

No abstract

Purpose: Washington, DC, has the highest prevalence of transgender persons in the United States at 2.8%. Transgender persons in DC have lower income, less stable housing, and more HIV infection than nontrans persons. Data are scarce regarding primary care quality among trans persons. We provide a detailed analysis of transgender patients at Whitman-Walker Health, an HIV- and LGBT-focused community health center.Methods: We performed a retrospective electronic medical record review of transgender patients ≥18 years of age from 2008 to 2016, evaluating demographic factors, HIV status, gender-affirming care, and primary care quality indicators.Results: Of 20,097 patients, 1822 (9.0%) self-identify as transgender (62.9% trans female and 37.2% trans male), and 18,275 were nontransgender. Transgender patients are more likely to be young, white, HIV negative, and reside outside Washington, DC, than nontrans patients. Transgender patients are more likely to engage in primary care and have a similar likelihood of mammogram and colonoscopy screening than nontrans patients. Trans males are more likely to be privately insured, have lower rates of HIV testing than nontrans patients, and have higher rates of cervical Pap smears than cis females. Trans females have a high prevalence of HIV infection (26.6%).Conclusion: This is the largest single-center U.S. transgender cohort to date. Over a quarter of trans females are HIV positive, consistent with a national prevalence of 27.7%. Transgender and nontrans patients do not receive statistically different quality of primary care. Trans patients' high engagement in primary care may result from providing hormone therapy and primary care within a single provider visit.

No abstract