Division of Plastic Surgery, Albany Medical Center, Albany, NY, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
J Sex Med. 2021 Jul;18(7):1280-1291. doi: 10.1016/j.jsxm.2021.04.006. Epub 2021 Jun 16.
Feminizing and masculinizing hormone treatments are established components of management in transgender patients. Exogenous hormones have been associated with hemostatic effects, which are well-studied in cis-gender individuals on hormone replacement therapy (HRT). Unfortunately, comprehensive understanding of their effects on venous thromboembolism (VTE) risk in the transgender population is lacking.
This manuscript aims to identify the risk of VTE among transgender individuals undergoing cross-sex hormone therapy.
A Systematic review of the literature was performed in March 2020 for studies reporting VTE rates in transgender patients undergoing hormone treatment and rates in cis-gender patients on HRT. Data regarding demographics, hormone therapy, and VTE incidence were collected and pooled for analysis.
The primary outcome of interest was the development of a VTE event in association with concurrent hormone administration.
Overall, 22 studies were included with 11 reporting VTE rates among transgender patients, 6 in cis-female patients, and 5 in cis-male patients. Data from 9,180 transgender patients (6,068 assigned male at birth [AMAB] and 3,112 assigned female at birth [AFAB]) undergoing hormone treatment and 103,713 cis-gender patients (18,748 female and 84,965 male) undergoing HRT were pooled. The incidence of VTE was higher in AMAB patients compared to AFAB patients (42.8 vs 10.8 VTE per 10,000 patient years; P = .02). The rate of VTE incidences in AMAB patients appears similar or higher than the rate demonstrated in cis-females on HRT. VTE incidence in AFAB patients, however, is similar to the published rates in cis-males on HRT.
AMAB patients on hormone therapy have higher VTE rates than AFAB patients. AMAB and AFAB patients may have similar VTE incidence to cis-female and cis-male patients on hormone replacement therapy, respectively.
STRENGTHS & LIMITATIONS: This is the first study to aggregate and quantify the development of VTE events in association with hormone therapy in transgender patients. It places these values in the context of rates published in more widely studied populations. It is limited by its retrospective data and heterogenic data.
Surgical planning regarding perioperative and postoperative VTE prophylaxis or cessation of hormone therapy should take into account each patient's Caprini risk assessment and the nature of each intervention. Kotamarti VS, Greige N, Heiman AJ, et al. Risk for Venous Thromboembolism in Transgender Patients Undergoing Cross-Sex Hormone Treatment: A Systematic Review. J Sex Med 2021;18:1280-1291.
女性化和男性化激素治疗是跨性别患者管理的既定组成部分。外源性激素与止血作用有关，这在接受激素替代疗法（HRT）的顺性别个体中已有充分研究。然而，人们对这些激素在跨性别人群中对静脉血栓栓塞（VTE）风险的影响缺乏全面的了解。
本研究旨在确定接受跨性别激素治疗的个体发生 VTE 的风险。
2020 年 3 月对文献进行了系统回顾，以检索报告跨性别患者在接受激素治疗时发生 VTE 率以及顺性别患者接受 HRT 时发生 VTE 率的研究。收集有关人口统计学、激素治疗和 VTE 发生率的数据，并进行汇总分析。
感兴趣的主要结局是与同时进行的激素治疗相关的 VTE 事件的发生。
共纳入 22 项研究，其中 11 项报告了跨性别患者的 VTE 发生率，6 项在顺性女性患者中，5 项在顺性男性患者中。共纳入了 9180 名接受激素治疗的跨性别患者（6068 名出生时被指定为男性[AMAB]，3112 名出生时被指定为女性[AFAB]）和 103713 名接受 HRT 的顺性别患者（18748 名女性和 84965 名男性）。与 AFAB 患者相比，AMAB 患者的 VTE 发生率更高（42.8 比 10.8 例/10000 患者年；P=0.02）。AMAB 患者的 VTE 发生率似乎与接受 HRT 的顺性女性相似或更高。然而，AFAB 患者的 VTE 发生率与接受 HRT 的顺性男性的报告率相似。
接受激素治疗的 AMAB 患者的 VTE 发生率高于 AFAB 患者。AMAB 和 AFAB 患者的 VTE 发生率可能分别与接受 HRT 的顺性女性和男性相似。
这是第一项汇总和量化与跨性别患者激素治疗相关的 VTE 事件发展的研究。它将这些数值置于在更广泛研究人群中公布的数值的背景下。其受到回顾性数据和异质数据的限制。
关于围手术期和术后 VTE 预防或停止激素治疗的手术计划应考虑每个患者的卡普兰风险评估和每个干预措施的性质。Kotamarti VS、Greige N、Heiman AJ 等。接受跨性别激素治疗的患者发生静脉血栓栓塞的风险：系统评价。J 性医学 2021；18：1280-1291。
