Incidence of Venous Thromboembolism in Transgender Women Receiving Oral Estradiol

Arnold, Justin D.; Sarkodie, Eleanor; Coleman, Megan; Goldstein, Deborah

doi:10.1016/j.jsxm.2016.09.001

Cited by 61 publications

(35 citation statements)

References 20 publications

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“…This is consistent with the limited evidence available in the literature that transgender adults are diagnosed with more chronic conditions. 1,10,35 Potentially disabling conditions were also much more common in TMBs than CMBs, including a range of mental health, neurological, and chronic pain conditions. Our findings on the potentially disabling mental health conditions were especially notable, indicating that those conditions were much more common in TMBs than in CMBs by upwards of 20 percentage points for most conditions.…”

Section: Trans Medicare Beneficiaries and Chronic Conditions 407 Discusmentioning

confidence: 99%

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data

et al. 2017

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Purpose: Data on the health and well-being of the transgender population are limited. However, using claims data we can identify transgender Medicare beneficiaries (TMBs) with high confidence. We seek to describe the TMB population and provide comparisons of chronic disease burden between TMBs and cisgender Medicare beneficiaries (CMBs), thus laying a foundation for national level TMB health disparity research. Methods: Using a previously validated claims algorithm based on ICD-9-CM codes relating to transsexualism and gender identity disorder, we identified a cohort of TMBs using Medicare Fee-for-Service (FFS) claims data. We then describe the demographic characteristics and chronic disease burden of TMBs (N = 7454) and CMBs (N = 39,136,229). Results: Compared to CMBs, a greater observed proportion of TMBs are young (under age 65) and Black, although these differences vary by entitlement. Regardless of entitlement, TMBs have more chronic conditions than CMBs, and more TMBs have been diagnosed with asthma, autism spectrum disorder, chronic obstructive pulmonary disease, depression, hepatitis, HIV, schizophrenia, and substance use disorders. TMBs also have higher observed rates of potentially disabling mental health and neurological/chronic pain conditions, as well as obesity and other liver conditions (nonhepatitis), compared to CMBs. Conclusion: This is the first systematic look at chronic disease burden in the transgender population using Medicare FFS claims data. We found that TMBs experience multiple chronic conditions at higher rates than CMBs, regardless of Medicare entitlement. TMBs under age 65 show an already heavy chronic disease burden which will only be exacerbated with age.

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Section: Trans Medicare Beneficiaries and Chronic Conditions 407 Discusmentioning

confidence: 99%

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data

et al. 2017

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“…Another retrospective study of 165 patients with matched controls demonstrated an eightfold increase in risk of VTE in transwomen treated with conjugated equine estrogen compared to oral or transdermal estradiol . One retrospective chart review of transwomen using oral estradiol found the incidence of VTE to be 7.8 per 10 000 patient‐years; patients were followed for a mean of 1.9 years with only one patient diagnosed with VTE . Although this incidence was low, with 1286 total patient‐years of follow‐up, the short duration of per‐patient follow‐up and the fact that data were based on chart review might not indicate the true thrombotic burden, as data described later suggest that the VTE risk associated with hormone therapy in transwomen continues to increase over time.…”

Section: Case I: Mtfmentioning

confidence: 99%

Transgender patients and the role of the coagulation clinician

Connors

2019

Journal of Thrombosis and Haemostasis

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The medical care of transgender patients relies on the use of sex hormones to develop and maintain the physical characteristics consistent with gender identity as the first step in transitioning. Hormonal therapy is usually continued indefinitely, even following gender‐affirming surgeries. The use of hormonal treatments is associated with a multitude of positive effects as well as complications and side effects. The risk of venous thromboembolism (VTE) is a major concern. Transgender patients are often referred to coagulation specialists for advice regarding an individual patient's risk for VTE, especially if there is a personal or family history of VTE. Coagulation specialists need to be familiar with endocrine therapy including the goals of treatment and the VTE risks associated with currently used hormone regimens. We will review common referral questions and the available data and their limitations for the use of hormonal therapy in transgender patients focusing on the risk of VTE.

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“…47 Because of this, intraoperative VTE prophylaxis in the form of subcutaneous heparin and sequential compression devices are essential. 49 …”

Section: Intraoperative Carementioning

confidence: 99%

The Perioperative Care of the Transgender Patient

Tollinche

Walters

Radix

et al. 2018

Anesthesia &Amp; Analgesia

104

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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Incidence of Venous Thromboembolism in Transgender Women Receiving Oral Estradiol

Cited by 61 publications

References 20 publications

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data

Transgender patients and the role of the coagulation clinician

The Perioperative Care of the Transgender Patient

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