Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy

Ott, Johannes; Kaufmann, Ulrike; Bentz, Eva-Katrin; Huber, Johannes; Tempfer, Clemens B.

doi:10.1016/j.fertnstert.2008.12.017

Cited by 120 publications

(78 citation statements)

References 15 publications

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“…In line with the Endocrine Society's Clinical practice guidelines on Endocrine Treatment of Transsexual Persons (25), we strongly recommend not to prescribe ethinyl estradiol (or OC, often selfadministered in higher dosages) to MtF transsexuals. Transdermal and low dose oral estradiol combined with anti-androgens are effective with fewer side effects in our experience and as published by others (26,27). Consequently, since ethinyl estradiol is no longer used in our clinic since 2001, there is no indication to routinely test asymptomatic MtF before initiation of cross-sex therapy for (inherited) forms of thrombophilia (27), as long as the subject's history does not suggest any additional risk (25).…”

Section: Use Of Ethinyl Estradiolsupporting

confidence: 62%

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

Asscheman

Giltay²,

Megens³

et al. 2011

European Journal of Endocrinology

474

379

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Objective: Adverse effects of long-term cross-sex hormone administration to transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones. Design: A cohort study with a median follow-up of 18.5 years at a university gender clinic. Methods: Mortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses. Results: In the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population. Conclusions: The increased mortality in hormone-treated MtF transsexuals was mainly due to nonhormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death. In the FtM transsexuals, use of testosterone in doses used for hypogonadal men seemed safe.

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Section: Use Of Ethinyl Estradiolsupporting

confidence: 62%

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

Asscheman

Giltay²,

Megens³

et al. 2011

European Journal of Endocrinology

474

379

View full text Add to dashboard Cite

show abstract

“…In Ott et al (2010), 162 transgender women were followed for a mean of 64.2 months, and there were no reports of VTE while using transdermal 17β estradiol [13]. Wilson et al (2009) also observed increases in inflammatory markers (cytokine IL-6, IL-1 and IL-8, clotting factors FV11 and FVIX and superoxide dismutase) consistent with this hypothesis for MTF individuals taking oral estrogen, but not for those taking transdermal estrogen [14].…”

Section: Cardiovascular Profilementioning

confidence: 99%

Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals

Weinand

Safer

2015

Journal of Clinical & Translational Endocrinology

106

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IntroductionSome providers report concern for the safety of transgender hormone therapy (HT).MethodsThis is a systematic literature review of HT safety for transgender adults.ResultsCurrent literature suggests HT is safe when followed carefully for certain risks. The greatest health concern for HT in transgender women is venous thromboembolism. HT among transgender men appears to cause polycythemia. Both groups experienced elevated fasting glucose. There is no increase in cancer prevalence or mortality due to transgender HT.ConclusionAlthough current data support the safety of transgender HT with physician supervision, larger, long-term studies are needed in transgender medicine.

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“…The use of high-dose oral ethinyl estradiol (100 mg OD) may explain the higher incidence in the latter study, as the type and route of administration of this estrogen are known to affect the coagulation system negatively (5,17,18). However, Ott et al (19) did not observe any venous thrombosis and/or pulmonary embolism incidents during their follow-up study of 162 trans women (mean age 36 years) who received transdermal 17b-estradiol therapy for an average of 4.4 years. This may be a safer type of estrogen and route of administration, although 37% of the trans women who experienced venous thromboses in our sample received transdermal 17b-estradiol therapy.…”

Section: Discussionmentioning

confidence: 85%

Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study

Wierckx¹,

Elaut

Declercq

et al. 2013

European Journal of Endocrinology

283

216

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Objective: This study evaluated the short-and long-term cardiovascular-and cancer-related morbidities during cross-sex hormone therapy in a large sample of trans persons. Subjects and methods: A specialist center cross-sectional study compared 214 trans women (male-to-female transsexual persons) and 138 trans men (female-to-male trans persons) with an age-and gender-matched control population (1-3 matching). The participants were on cross-sex hormone therapy for an average of 7.4 years. We assessed physical health and possible treatmentrelated adverse events using questionnaires. Results: Five percent of trans women experienced venous thrombosis and/or pulmonary embolism during hormone therapy. Five of these adverse events occurred during the first year of treatment, while another three occurred during sex reassignment surgery. Trans women experienced more myocardial infarctions than the control women (PZ0.001), but a similar proportion compared with control men. The prevalence of cerebrovascular disease (CVD) was higher in trans women than in the control men (PZ0.03). The rates of myocardial infarction and CVD in trans men were similar to the control male and female subjects. The prevalence of type 2 diabetes was higher in both trans men and women than in their respective controls, whereas the rates of cancer were similar compared with the control men and women. Conclusion: Morbidity rate during cross-sex hormone therapy was relatively low, especially in trans men. We observed a higher prevalence of venous thrombosis, myocardial infarction, CVD, and type 2 diabetes in trans women than in the control population. Morbidity rates in trans men and controls were similar, with the exception of the increased prevalence of type 2 diabetes.

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Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy

Cited by 120 publications

References 15 publications

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals

Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study

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