Effect of gender‐affirming hormone use on coagulation profiles in transmen and transwomen

Scheres, Luuk J. J.; Selier, Nienke L. D.; Nota, Nienke M.; Diemen, Jeske Joanna Katarina van; Cannegieter, Suzanne C.; Heijer, Martin den

doi:10.1111/jth.15256

Cited by 40 publications

(37 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In accordance, the incidence of VTE was increased in transgender women with 2-and 8-year risk differences of 4.1 (95% CI, 1.6-6.7) and 16.7 (6.4-27.5) per 1000 persons relative to cisgender men and 3.4 (1.1-5.6) and 13.7 (4.1-22.7) relative to cisgender women (88). Measurement of coagulation markers confirmed procoagulant changes during the initiation of GAHT (89).…”

Section: Venous Thromboembolism (Vte)mentioning

confidence: 70%

See 1 more Smart Citation

MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people

Glintborg

T’Sjoen

Ravn

et al. 2021

European Journal of Endocrinology

View full text Add to dashboard Cite

Transgender women are assigned male at birth, but identify as women. The incidence of gender dysphoria is estimated to be around 1% of the population. Gender dysphoria may be associated with depression and low quality of life, which in most cases improves during gender affirming hormonal treatment (GAHT). Feminizing hormonal treatment for transgender women or gender non-binary people typically includes natural estrogen (estradiol). Additional testosterone-blocking treatment is often needed to ensure suppression of the pituitary gonadal axis and may include cyproterone acetate, a gonadotropin releasing hormone agonist (GnRH-a) or spironolactone. The health risks of cyproterone acetate as anti-androgen treatment are debated and randomized protocols with other anti-androgen treatments are requested. Orchiectomy is performed in some transgender women after various duration of GAHT. Currently, natural progesterone is not recommended as part of GAHT due to limited knowledge on the balance between risks and benefits. In the present article we discuss evidence regarding established and upcoming feminizing treatment for adult transgender women or for gender non-binary people seeking feminization. Data on study populations with transgender women are put into a wider context of literature regarding effects of sex steroid hormones in cisgender study populations. Relevant follow up and monitoring during feminizing treatment is debated. The review has special focus on the pharmacotherapy of feminizing hormonal therapy.

show abstract

Section: Venous Thromboembolism (Vte)mentioning

confidence: 70%

“…Other risk factors for VTE include BMI > 25 kg/m 2 , genetic factors and previous VTE (90,91). The route of estrogen administration affects the risk of VTE (89,91). Oral E2 changes hemostatic variables in a pro-thrombotic direction in contrast to transdermal E2, which was similar to placebo in a recent meta-analysis (91).…”

Section: Venous Thromboembolism (Vte)mentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people

Glintborg

T’Sjoen

Ravn

et al. 2021

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…The concentration of the coagulation marker fibrinogen transiently increased after 3 months of transdermal estradiol combined with CPA. Similarly, a recent study on the effect of GAHT on coagulation parameters observed more procoagulant profiles in trans women [ 33 ]. Our observed increase in fibrinogen concentration after 3 months of hormone therapy may indicate temporarily increased pro-coagulant activity.…”

Section: Discussionmentioning

confidence: 81%

The effect of transdermal gender-affirming hormone therapy on markers of inflammation and hemostasis

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Cardiovascular risk is increased in transgender persons using gender-affirming hormone therapy. To gain insight into the mechanism by which sex hormones affect cardiovascular risk in transgender persons, we investigated the effect of hormone therapy on markers of inflammation and hemostasis. Methods In this exploratory study, 48 trans women using estradiol patches plus cyproterone acetate (CPA) and 47 trans men using testosterone gel were included. They were between 18 and 50 years old and did not have a history of cardiovascular events. Measurements were performed before and after 3 and 12 months of hormone therapy. Results After 12 months, in trans women, systemic and endothelial inflammatory markers decreased (hs-CRP -66%, (95% CI -76; -53), VCAM-1–12%, (95% CI -16; -8)), while platelet activation markers increased (PF-4 +17%, (95% CI 4; 32), β-thromboglobulin +13%, (95% CI 2; 24)). The coagulation marker fibrinogen increased transiently, after 3 months (+15%, (95% CI 1; 32)). In trans men, hs-CRP increased (+71%, (95% CI 19; 145)); platelet activation and coagulation markers were not altered. In both trans women and trans men, leptin and adiponectin changed towards reference values of the experienced gender. Conclusions Platelet activation and coagulation marker concentrations increased in trans women using transdermal estradiol plus CPA, but not in trans men using testosterone. Also, concentrations of inflammatory markers decreased in trans women, while hs-CRP increased in trans men. Our results indicate that hormone therapy may affect hemostasis in transgender persons, which could be an underlying mechanism explaining the increased cardiovascular risk in this population.

show abstract

“…Several studies have observed that despite the negative effects of testosterone therapy on surrogate risks factors of CV disease, these do not translate into a significant effect on CV outcomes (Table 2). Furthermore, no elevated rates of CV deaths have been observed when compared with cisgender men and women at short and medium follow-up (30,35,40,56).…”

Section: Cardiovascular Outcomes In Transgender Menmentioning

confidence: 98%

“…A systematic review and meta-analysis of CV outcomes in transgender people reported few cases of myocardial infarction (MI), stroke, or venous thrombosis; however, the incidence was higher in transgender women compared to transgender men (35,40).…”

Section: Cardiovascular Outcomes In Transgender Womenmentioning

confidence: 99%

Cardiovascular Risk Associated With Gender Affirming Hormone Therapy in Transgender Population

et al. 2021

View full text Add to dashboard Cite

Transgender men and women represent about 0.6 -1.1%% of the general population. Gender affirming hormone therapy (GAHT) helps ameliorate gender dysphoria and promote well-being. However, these treatments’ cardiovascular (CV) effects are difficult to evaluate due to the limited number of extensive longitudinal studies focused on CV outcomes in this population. Furthermore, these studies are mainly observational and difficult to interpret due to a variety of hormone regimens and observation periods, together with possible bias by confounding factors (comorbidities, estrogen types, smoking, alcohol abuse, HIV infection). In addition, the introduction of GAHT at increasingly earlier ages, even before the full development of the secondary sexual characteristics, could lead to long-term changes in CV risk compared to current data.This review examines the impact of GAHT in the transgender population on CV outcomes and surrogate markers of CV health. Furthermore, we review available data on changes in DNA methylation or RNA transcription induced by GAHT that may translate into changes in metabolic parameters that could increase CV risk.

show abstract

Effect of gender‐affirming hormone use on coagulation profiles in transmen and transwomen

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 40 publications

References 46 publications

MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people

MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people

The effect of transdermal gender-affirming hormone therapy on markers of inflammation and hemostasis

Cardiovascular Risk Associated With Gender Affirming Hormone Therapy in Transgender Population

Contact Info

Product

Resources

About