Deep vein thrombosis in a transgender woman

Chan, Wesley; Drummond, Alasdair; Kelly, Martina

doi:10.1503/cmaj.160408

Cited by 21 publications

(12 citation statements)

References 9 publications

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“…Furthermore, given the low frequency of genetic mutations associated with thrombosis (19 out of 162), the authors do not recommend routine screening for thrombophilia. There have been reports of transgender women who developed a thrombotic event and successfully treated with anti-coagulation therapy (88,89).…”

Section: Cardiovascular and Thromboembolic Safetymentioning

confidence: 99%

Endocrinology of Transgender Medicine

et al. 2018

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Gender affirming treatment for transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen lowering medications. Feminizing treatment with estrogens and anti-androgens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk of venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses plus increase of muscle mass, facial and body hair. Due to the lack of evidence, treatment for gender non-binary people should be individualized. Young people may receive pubertal suspension, consisting of gonadotrophinreleasing hormone analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur, but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to effect of gender affirming treatment in the non-binary population. PrécisReview of original and recent data on hormonal treatment in transgender people, including their effect on physical and mental health Endocrinology of Transgender Medicine manuscript, the term transgender will be used throughout to describe individuals who seek access to medical treatment in order for their bodies to become more congruent to their identified gender. A summary of some of the terms used in transgender health can be found in table 1. Methodology Eligibility criteriaStudies were selected only if participants were described as transgender (whether self-identified or diagnosed by health professionals), and had empirical data relating to the hormonal treatment in this population. Only studies in English, published in peer reviewed journals and with more than ten participants were selected. This is a critical review with a focus on recent and original data. This paper describes and reviews the available literature since the last published review study by one of the coauthors of the current review(9). Information Sources and SearchAn electronic literature search was conducted between January 1999 and November 2017 using Medline/Pubmed, PsycINFO and Embase. Additionally, reference sections of identified articles and Google Scholar were examined for further relevant publications. The search u...

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Section: Cardiovascular and Thromboembolic Safetymentioning

confidence: 99%

Endocrinology of Transgender Medicine

et al. 2018

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“…Of note, there was one patient mortality in this series from a presumed pulmonary embolism and a deep vein thrombosis in another. The safety and thrombogenesis of hormonal supplementation in transwomen have been the subject of much inquiry [ 28 – 30 ]. WPATH SOC criteria require 12 continuous months of hormone therapy before genital surgery in male-to-female transgender patients [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Primary Sigmoid Vaginoplasty in Transwomen: Technique and Outcomes

Salgado

Nugent

Kuhn

et al. 2018

BioMed Research International

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Background Many techniques have been described for reconstruction of the vaginal canal for oncologic, traumatic, and congenital indications. An increasing role exists for these procedures within the transgender community. Most often, inverted phallus skin is used to create the neovagina in transwomen. However, not all patients have sufficient tissue to achieve satisfactory depth and those that do must endure cumbersome postoperative dilation routines to prevent contracture. In selected patients, the sigmoid colon can be used to harvest ample tissue while avoiding the limitations of penile inversion techniques. Methods Records were retrospectively reviewed for all transwomen undergoing primary sigmoid vaginoplasty with the University of Miami Gender Reassignment service between 2014 and 2017. Results Average neovaginal depth was 13.9 +/− 2.0 centimeters in 12 patients. 67% were without complications, and all maintained tissue conducive to sexual activity. No incidences of bowel injury, anastomotic leak, sigmoid necrosis, prolapse, diversion neovaginitis, dyspareunia, or excessive secretions had occurred at last follow-up. Conclusions Sigmoid vaginoplasty is a reliable technique for achieving a satisfactory vaginal depth that is sexually functional. Using a collaborative approach, it is now our standard of care to offer this surgery to transwomen with phallus length less than 11.4 centimeters.

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“…42 Adverse effects such as erythrocytosis, liver dysfunction, lipid level changes, acne, and adverse psychological changes can also occur. 44 If patients stop their hormones for longer periods, this can result in reversal of the masculinizing effects, including loss of muscle mass and resumption of menses.…”

Section: Preoperative Carementioning

confidence: 99%

The Perioperative Care of the Transgender Patient

Tollinche

Walters

Radix

et al. 2018

Anesthesia &Amp; Analgesia

103

123

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An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient.

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Deep vein thrombosis in a transgender woman

Abstract: A 44-year-old woman presented to a rural emergency

Cited by 21 publications

References 9 publications

Endocrinology of Transgender Medicine

Endocrinology of Transgender Medicine

Primary Sigmoid Vaginoplasty in Transwomen: Technique and Outcomes

The Perioperative Care of the Transgender Patient

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