Bouck Emma G, Grinsztejn Eduarda, Mcnamara Megan, Stavrou Evi X, Wolberg Alisa S
Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill, NC, USA.
Department of Medicine, Hematology and Oncology Division, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Res Pract Thromb Haemost. 2023 Sep 2;7(6):102197. doi: 10.1016/j.rpth.2023.102197. eCollection 2023 Aug.
Gender-affirming hormonal therapies are a critical component of the care of transgender individuals. Transgender people are commonly prescribed estrogen or testosterone to promote male-to-female or female-to-male transitions and to preserve gender-specific characteristics long-term. However, some exogenous hormones, especially certain estrogen preparations, are an established risk factor of thrombosis. As the number of individuals seeking gender-based care is rising, there is an urgent need to identify and characterize the mechanisms underlying hormone-associated thrombosis and incorporate this information into clinical algorithms for diagnosis and management. Herein, we discuss historical evidence on the incidence of thrombosis and changes in plasma composition in transgender and cisgender cohorts. We present 3 case studies to demonstrate knowledge gaps in thrombosis risk stratification and prediction tools. We also present data from coagulation and fibrinolysis assays and discuss how information from these kinds of assays may be used to help guide the clinical management of transgender individuals.
性别肯定激素疗法是跨性别者护理的关键组成部分。跨性别者通常会被开雌激素或睾酮，以促进男性向女性或女性向男性的转变，并长期维持特定性别的特征。然而，一些外源性激素，尤其是某些雌激素制剂，是已确定的血栓形成风险因素。随着寻求性别相关护理的人数不断增加，迫切需要识别并描述激素相关血栓形成的潜在机制，并将这些信息纳入诊断和管理的临床算法中。在此，我们讨论了跨性别和顺性别队列中血栓形成发生率及血浆成分变化的历史证据。我们展示了3个案例研究，以证明血栓形成风险分层和预测工具方面的知识空白。我们还展示了凝血和纤维蛋白溶解试验的数据，并讨论了如何利用这类试验的信息来指导跨性别者的临床管理。
