Scheres Luuk J J, Selier Nienke L D, Nota Nienke M, van Diemen Jeske J K, Cannegieter Suzanne C, den Heijer Martin
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
J Thromb Haemost. 2021 Apr;19(4):1029-1037. doi: 10.1111/jth.15256. Epub 2021 Feb 22.
The transgender population that uses gender-affirming hormone therapy (GAHT) is rapidly growing. The (side) effects of GAHT are largely unknown. We examined the effect of GAHT on coagulation parameters associated with venous thromboembolism (VTE) risk.
Factor (F)II, FIX, FXI, protein (p)C and free pS, fibrinogen, hematocrit, sex hormone-binding globulin, and normalized activated protein C ratio were measured in 98 transwomen (male sex at birth, female gender identity) and 100 transmen (female sex at birth, male gender identity) before and after 12 months of GAHT (oral or transdermal estradiol and anti-androgens in transwomen, transdermal or intramuscular testosterone in transmen). Mean paired differences in coagulation measurements were estimated with 95% confidence intervals (95% CI). Differences for route of administration and age were assessed with linear regression.
After GAHT, transwomen had more procoagulant profiles with a mean increase in FIX: 9.6 IU/dL (95% CI 3.1-16.0) and FXI: 13.5 IU/dL (95% CI 9.5-17.5), and a decrease in pC: -7.7 IU/dL (95% CI -10.1 to -5.2). Changes in measures of coagulation were influenced by route of administration (oral vs. transdermal) and age. A higher sex-hormone binding globulin level after 12 months was associated with a lower activated protein C resistance. In transmen, changes were not procoagulant overall and were influenced by age. Differences for route of administration (transdermal vs. intramuscular) were small.
GAHT in transmen was not associated with apparent procoagulant changes, which provides some reassurance regarding VTE risk. In transwomen, GAHT resulted in procoagulant changes, which likely contributes to the observed increased VTE risk.
接受性别确认激素疗法（GAHT）的 transgender 人群正在迅速增长。GAHT 的（副）作用在很大程度上尚不清楚。我们研究了 GAHT 对与静脉血栓栓塞（VTE）风险相关的凝血参数的影响。
在 98 名跨性别女性（出生时为男性性别，女性性别认同）和 100 名跨性别男性（出生时为女性性别，男性性别认同）接受 GAHT 12 个月前后（跨性别女性使用口服或经皮雌二醇和抗雄激素，跨性别男性使用经皮或肌肉注射睾酮），测量了因子（F）II、FIX、FXI、蛋白（p）C 和游离 pS、纤维蛋白原、血细胞比容、性激素结合球蛋白以及标准化活化蛋白 C 比值。用 95%置信区间（95%CI）估计凝血测量值的平均配对差异。通过线性回归评估给药途径和年龄的差异。
GAHT 后，跨性别女性的促凝血特征更为明显，FIX 平均增加：9.6 IU/dL（95%CI 3.1 - 16.0），FXI 平均增加：13.5 IU/dL（95%CI 9.5 - 17.5），pC 平均降低：-7.7 IU/dL（95%CI -10.1 至 -5.2）。凝血指标的变化受给药途径（口服与经皮）和年龄的影响。12 个月后较高的性激素结合球蛋白水平与较低的活化蛋白 C 抵抗相关。在跨性别男性中，总体变化并非促凝血性的，且受年龄影响。给药途径（经皮与肌肉注射）的差异较小。
跨性别男性的 GAHT 与明显的促凝血变化无关，这为 VTE 风险提供了一些安心的依据。在跨性别女性中，GAHT 导致了促凝血变化，这可能是观察到的 VTE 风险增加的原因。
