Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Center for Transgender Medicine and Surgery, Mount Sinai Health System, New York, NY, USA.
J Clin Endocrinol Metab. 2021 Mar 25;106(4):e1586-e1590. doi: 10.1210/clinem/dgaa966.
Both surgery and exogenous estrogen use are associated with increased risk of venous thromboembolism (VTE). However, it is not known whether estrogen hormone therapy (HT) exacerbates the surgery-associated risk among transgender and gender nonbinary (TGNB) individuals. The lack of published data has contributed to heterogeneity in perioperative protocols regarding estrogen HT administration for TGNB patients undergoing gender-affirming surgery.
A single-center retrospective chart review was performed on all TGNB patients who underwent gender-affirming surgery between November 2015 and August 2019. Surgery type, preoperative HT regimen, perioperative HT regimen, VTE prophylaxis management, outcomes, and demographic data were recorded.
A total of 919 TGNB patients underwent 1858 surgical procedures representing 1396 unique cases, of which 407 cases were transfeminine patients undergoing primary vaginoplasty. Of the latter, 190 cases were performed with estrogen suspended for 1 week prior to surgery, and 212 cases were performed with HT continued throughout. Of all cases, 1 patient presented with VTE, from the cohort of transfeminine patients whose estrogen HT was suspended prior to surgery. No VTE events were noted among those who continued HT. Mean postoperative follow-up was 285 days.
Perioperative VTE was not a significant risk in a large, homogenously treated cohort of TGNB patients independent of whether HT was suspended or not prior to surgery.
手术和外源性雌激素的使用都与静脉血栓栓塞症（VTE）风险增加有关。然而，目前尚不清楚雌激素激素疗法（HT）是否会加剧跨性别和性别非二元（TGNB）个体与手术相关的风险。缺乏已发表的数据导致了 TGNB 患者在接受性别肯定手术时围手术期雌激素 HT 管理方面的方案存在异质性。
对 2015 年 11 月至 2019 年 8 月期间接受性别肯定手术的所有 TGNB 患者进行了一项单中心回顾性图表审查。记录了手术类型、术前 HT 方案、围手术期 HT 方案、VTE 预防管理、结果和人口统计学数据。
共有 919 名 TGNB 患者接受了 1858 次手术，代表了 1396 例独特的病例，其中 407 例为接受原发性阴道成形术的跨女性患者。在后一组中，有 190 例在手术前停止雌激素治疗 1 周，212 例继续使用 HT。在所有病例中，有 1 例患者出现 VTE，该患者来自于术前停止雌激素 HT 的跨女性患者队列。在继续使用 HT 的患者中，没有观察到 VTE 事件。平均术后随访 285 天。
在一个大型、同质化治疗的 TGNB 患者队列中，围手术期 VTE 不是一个显著的风险，无论术前是否暂停 HT。
