Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli (IS), Italy.
Front Endocrinol (Lausanne). 2021 Nov 9;12:741866. doi: 10.3389/fendo.2021.741866. eCollection 2021.
Although venous thromboembolism (VTE) is a recognized side effect of some formulations of estrogen therapy, its impact in transgender people remains uncertain. The aim of this study was to define pooled prevalence estimate and correlates of VTE in Assigned Males at Birth (AMAB) trans people undergoing gender affirming hormone therapy.
A thorough search of MEDLINE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases was carried out to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effects models and the between-study heterogeneity was assessed by the Cochrane's Q and I.
The eighteen studies included gave information about 11,542 AMAB undergoing gender affirming hormone therapy. The pooled prevalence of VTE was 2% (95%CI:1-3%), with a large heterogeneity (I = 89.18%, P<0.0001). Trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimate. At the meta-regression analysis, a higher prevalence of VTE was significantly associated with an older age (S=0.0063; 95%CI:0.0022,0.0104, P=0.0027) and a longer length of estrogen therapy (S=0.0011; 95%CI:0.0006,0.0016, P<0.0001). When, according to the meta-regression results, the analysis was restricted to series with a mean age ≥37.5 years, the prevalence estimate for VTE increased up to 3% (95%CI:0-5%), but with persistence of a large heterogeneity (I = 88,2%, P<0.0001); studies on younger participants (<37.5 years) collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-2%) with no heterogeneity (I = 0%, P=0.97). Prevalence estimate for VTE in series with a mean length of estrogen therapy ≥53 months was 1% (95%CI:0-3%), with persistent significant heterogeneity (I = 84,8%, P=0.0006); studies on participants subjected to a shorter length of estrogen therapy (<53 months), collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-3%) with no heterogeneity (I = 0%, P=0.76).
The overall rate of VTE in AMAB trans people undergoing gender affirming hormone therapy was 2%. In AMAB population with <37.5 years undergoing estrogen therapy for less than 53 months, the risk of VTE appears to be negligible. Further studies are warranted to assess whether different types and administration routes of estrogen therapy could decrease the VTE risk in AMAB trans people over 37.5 years subjected to long-term therapy.
[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021229916].
虽然静脉血栓栓塞症（VTE）是某些雌激素治疗方案的已知副作用，但在跨性别者中的影响仍不确定。本研究旨在定义接受性别肯定激素治疗的出生时被指定为男性的跨性别者（AMAB）中 VTE 的汇总患病率估计值和相关因素。
对 MEDLINE、COCHRANE 图书馆、SCOPUS 和 WEB OF SCIENCE 数据库进行了全面检索，以确定合适的研究。使用患病率研究评估工具对文章进行了质量评分。使用随机效应模型合并数据，并使用 Cochrane's Q 和 I 评估研究间异质性。
18 项研究提供了 11542 名接受性别肯定激素治疗的 AMAB 信息。VTE 的汇总患病率为 2%（95%CI：1-3%），存在较大的异质性（I = 89.18%，P<0.0001）。对发表偏倚进行修剪和填充调整对汇总估计值的影响可忽略不计。在荟萃回归分析中，VTE 的较高患病率与年龄较大（S=0.0063；95%CI：0.0022，0.0104，P=0.0027）和雌激素治疗时间较长（S=0.0011；95%CI：0.0006，0.0016，P<0.0001）显著相关。根据荟萃回归结果，当分析仅限于平均年龄≥37.5 岁的系列时，VTE 的患病率估计值上升至 3%（95%CI：0-5%），但仍存在较大的异质性（I = 88，2%，P<0.0001）；年龄较小（<37.5 岁）的参与者的研究共同产生了 0%（95%CI：0-2%）的汇总 VTE 患病率估计值，且无异质性（I = 0%，P=0.97）。在平均雌激素治疗时间≥53 个月的系列中，VTE 的患病率估计值为 1%（95%CI：0-3%），且存在持续显著的异质性（I = 84.8%，P=0.0006）；接受较短雌激素治疗时间（<53 个月）的参与者的研究共同产生了 0%（95%CI：0-3%）的汇总 VTE 患病率估计值，且无异质性（I = 0%，P=0.76）。
接受性别肯定激素治疗的 AMAB 中 VTE 的总体发生率为 2%。在年龄<37.5 岁且接受雌激素治疗时间<53 个月的 AMAB 人群中，VTE 的风险似乎可以忽略不计。需要进一步的研究来评估不同类型和给药途径的雌激素治疗是否可以降低年龄>37.5 岁且接受长期治疗的 AMAB 中 VTE 的风险。
[https://www.crd.york.ac.uk/PROSPERO/]，标识符 [CRD42021229916]。
