Abstract
Gender-affirming therapy involves the use of hormones to develop the physical characteristics
of the identified gender and suppressing endogenous sex hormone production. Venous
thromboembolism (VTE) is a known risk of exogenous estrogen therapy, and while evidence
of VTE risk among transgender women using modern gender-affirming hormone therapy
(GAHT) is still emerging, it is thought to affect up to 5% of transgender women. Historically,
GAHT was associated with a high risk of VTE; however, modern preparations are less
thrombogenic mainly due to significantly lower doses used as well as different preparations.
This review presents the available literature regarding the following four topics:
(1) risk of VTE among transgender women receiving estradiol GAHT, (2) how the route
of administration of estradiol affects the VTE risk, (3) perioperative management
of GAHT, (4) VTE risk among adolescents on GAHT. There is a need for large, longitudinal
studies of transgender women using GAHT to further characterize VTE risk and how this
is affected by factors such as patient age, duration of GAHT use, tobacco use, body
mass index, and comorbidities. Future studies in these areas could inform the development
of clinical guidelines to improve the care of transgender people.
Keywords
transgender - estrogen - venous thromboembolism - hormone therapy - gender
