Thrombotic issues in transgender medicine: A review

Abstract

Clinicians, including hematologists, are more frequently encountering transgender individuals in practice; however, most lack training on the management and complications of transgender medicine. Hormonal therapy forms the backbone of medical interventions for patients undergoing gender transition. While supplementing an individual's intrinsic sex hormone is associated with a variety of hematologic complications including increased rates of venous thrombosis, cardiovascular events, erthyrocytosis, and malignancy, the risks of supplementing with opposing sex hormones are not well understood. Data on the hematologic complications of these therapies are accumulating but remain limited, and clinicians have little experience with their management. This review highlights the current interventions available in transgender medicine and related potential hematologic complications, and it suggests simple, evidence-based management going forward.

Cross‐sex hormone therapy in Australia: the prescription patterns of clinicians experienced in adult transgender healthcare

“…However, there have been no prospective, randomised controlled trials evaluating oral versus transdermal estradiol in any population (transgender or postmenopausal women), and any observational case–control studies have been conducted on relatively high‐risk populations in postmenopausal women . One large population‐based study of postmenopausal women has shown a similar increased risk of stroke when comparing oral estradiol and high‐dose (>50 mcg/day) transdermal estradiol – those typically used in trans females; however, in contrast, meta‐analyses suggest that transdermal oestrogens carry minimal or no thrombotic risk, with minimal effects on haemostatic variables . Without data for the transgender population specifically, we must extrapolate based on studies of postmenopausal women.…”

Can a transgender person be an occupational diver? Demonstration from a case report

“…For this diver, a priori, there was therefore no medical contraindication against diving. It should be borne in mind, however, that the embolic risk is increased among transgender people [20]. The physician should be vigilant and stay informed of scientific advances in this regard.…”

Oestrogen and anti-androgen therapy for transgender women

“…However, many of the studies were small and very short in follow-up time. 47 Furthermore, many venous thrombotic events are likely to be under-reported. Data from early studies in transgender women in the Netherlands suggested a high lifetime prevalence (about 5% over a mean of 10 years of follow-up) of thromboembolic disease.…”