Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.
Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.
Yale J Biol Med. 2020 Sep 30;93(4):539-548. eCollection 2020 Sep.
Venous thromboembolism is a documented risk of some estradiol formulations, but evidence evaluating the perioperative risk of continuation of estradiol therapy is limited. This narrative review summarizes literature related to the perioperative venous thromboembolic risk of estradiol, with a focus on feminizing genitoplasty for trans people undergoing feminizing hormone therapy. Given the dearth of evidence underlying gender-affirming hormone therapy regimens, much of the risk is based on the menopausal hormone therapy literature. However, the doses used for trans people undergoing feminizing hormone therapy can be significantly higher than those used for menopausal hormone therapy and escalating estradiol dose is associated with an increased thrombotic risk. Transdermal formulations are not associated with an increased risk in postmenopausal people. Feminizing genitoplasty is associated with a low thromboembolic risk. However, many patients are instructed to cease estradiol therapy several weeks preoperatively based on reports of increased thrombotic risk in trans people undergoing feminizing hormone therapy and hemostatic changes with the oral contraceptive pill. This can result in psychological distress and vasomotor symptoms. There is insufficient evidence to support routine discontinuation of estradiol therapy in the perioperative period. There is a need for high-quality prospective trials evaluating the perioperative risk of estradiol therapy in trans people undergoing feminizing hormone therapy to formulate evidence-based recommendations.
静脉血栓栓塞是某些雌二醇制剂的已证实风险，但评估继续雌二醇治疗的围手术期风险的证据有限。本叙述性综述总结了与雌二醇围手术期静脉血栓栓塞风险相关的文献，重点关注接受女性化激素治疗的跨性别者的女性化生殖器成形术。鉴于性别肯定激素治疗方案的证据不足，许多风险基于绝经后激素治疗文献。然而，跨性别者接受女性化激素治疗的剂量可能明显高于绝经后激素治疗的剂量，且雌二醇剂量增加与血栓形成风险增加相关。经皮制剂与绝经后人群的风险增加无关。女性化生殖器成形术与血栓栓塞风险低相关。然而，许多患者根据接受女性化激素治疗的跨性别者血栓形成风险增加的报告和口服避孕药引起的止血变化，被指示在术前数周停止雌二醇治疗。这可能导致心理困扰和血管舒缩症状。没有足够的证据支持在围手术期常规停止雌二醇治疗。需要高质量的前瞻性试验来评估接受女性化激素治疗的跨性别者的雌二醇治疗的围手术期风险，以制定基于证据的建议。
