Kaiser Permanente Southern California, Pasadena, California (D.G., T.A.B., V.P.Q.).
Emory University, Atlanta, Georgia (R.N., W.D.F., T.L.L., M.G.).
Ann Intern Med. 2018 Aug 21;169(4):205-213. doi: 10.7326/M17-2785. Epub 2018 Jul 10.
Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use.
To examine the incidence of these events in a cohort of transgender persons.
Electronic medical record-based cohort study of transgender members of integrated health care systems who had an index date (first evidence of transgender status) from 2006 through 2014. Ten male and 10 female cisgender enrollees were matched to each transgender participant by year of birth, race/ethnicity, study site, and index date enrollment.
Kaiser Permanente in Georgia and northern and southern California.
2842 transfeminine and 2118 transmasculine members with a mean follow-up of 4.0 and 3.6 years, respectively, matched to 48 686 cisgender men and 48 775 cisgender women.
VTE, ischemic stroke, and myocardial infarction events ascertained from diagnostic codes through the end of 2016 in transgender and reference cohorts.
Transfeminine participants had a higher incidence of VTE, with 2- and 8-year risk differences of 4.1 (95% CI, 1.6 to 6.7) and 16.7 (CI, 6.4 to 27.5) per 1000 persons relative to cisgender men and 3.4 (CI, 1.1 to 5.6) and 13.7 (CI, 4.1 to 22.7) relative to cisgender women. The overall analyses for ischemic stroke and myocardial infarction demonstrated similar incidence across groups. More pronounced differences for VTE and ischemic stroke were observed among transfeminine participants who initiated hormone therapy during follow-up. The evidence was insufficient to allow conclusions regarding risk among transmasculine participants.
Inability to determine which transgender members received hormones elsewhere.
The patterns of increases in VTE and ischemic stroke rates among transfeminine persons are not consistent with those observed in cisgender women. These results may indicate the need for long-term vigilance in identifying vascular side effects of cross-sex estrogen.
Patient-Centered Outcomes Research Institute and Eunice Kennedy Shriver National Institute of Child Health and Human Development.
静脉血栓栓塞症（VTE）、缺血性卒中和 transgender 人群中的心肌梗死可能与激素使用有关。
在 transgender 人群队列中检查这些事件的发生率。
基于电子病历的队列研究，纳入了 2006 年至 2014 年期间具有索引日期（首次出现 transgender 状态的证据）的 Kaiser Permanente 综合医疗保健系统的 transgender 成员。每 10 名男性 transgender 和 10 名女性 transgender 参与者与一名 transgender 参与者相匹配，匹配因素包括出生年份、种族/民族、研究地点和索引日期入组。
佐治亚州和加利福尼亚州北部和南部的 Kaiser Permanente。
2842 名 transfeminine 和 2118 名 transmasculine 成员，平均随访时间分别为 4.0 年和 3.6 年，与 48686 名 cisgender 男性和 48775 名 cisgender 女性相匹配。
通过诊断代码在 transgender 和参考队列中确定 VTE、缺血性卒中和心肌梗死事件，截止到 2016 年底。
transfeminine 参与者的 VTE 发生率较高，与 cisgender 男性相比，2 年和 8 年的风险差异分别为 4.1（95%CI，1.6 至 6.7）和 16.7（CI，6.4 至 27.5），与 cisgender 女性相比，2 年和 8 年的风险差异分别为 3.4（CI，1.1 至 5.6）和 13.7（CI，4.1 至 22.7）。对于缺血性卒中和心肌梗死的总体分析显示，各组的发病率相似。在随访期间开始接受激素治疗的 transfeminine 参与者中，VTE 和缺血性卒中的差异更为明显。由于无法确定 transgender 参与者在其他地方接受了激素治疗，因此无法得出关于 transmasculine 参与者风险的结论。
无法确定 transgender 成员在哪里接受了激素治疗。
transfeminine 人群中 VTE 和缺血性卒中发生率的增加模式与 cisgender 女性观察到的模式不一致。这些结果可能表明需要长期警惕识别跨性别雌激素的血管副作用。
患者导向的结果研究所和 Eunice Kennedy Shriver 国家儿童健康与人类发展研究所。
