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Thromb Haemost 2024; 124(05): 387-398
DOI: 10.1055/a-2188-8898
Review Article

Venous Thromboembolism and Estrogen-Containing Gender-Affirming Hormone Therapy

Caroline Dix 
1   Department of Clinical Haematology, The Alfred Hospital, Melbourne, Australia
,
Mollie Moloney
2   Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
,
Huyen A. Tran
1   Department of Clinical Haematology, The Alfred Hospital, Melbourne, Australia
2   Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
,
James D. McFadyen
1   Department of Clinical Haematology, The Alfred Hospital, Melbourne, Australia
2   Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
3   Atherothrombosis and Vascular Biology Program, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
› Author Affiliations
Funding J.D.M. is supported by a Heart Foundation Future Leader Fellowship.
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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

Authors' Contribution

M.M. performed the literature review and wrote the manuscript; C.D. performed the literature review and wrote the manuscript. J.D.M. wrote and reviewed the manuscript. H.T. wrote and reviewed the manuscript.




Publication History

Received: 14 June 2023

Accepted: 09 October 2023

Accepted Manuscript online:
10 October 2023

Article published online:
02 November 2023

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