Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.
Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA; Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
J Thromb Haemost. 2024 Aug;22(8):2129-2139. doi: 10.1016/j.jtha.2024.05.015. Epub 2024 May 23.
Transgender and gender-expansive (TG) people-those who identify with a gender other than their assigned sex at birth-frequently experience gender dysphoria, which is associated with negative health outcomes. One key strategy for improving gender dysphoria is the use of gender-affirming hormone therapy (GAHT): estrogen for feminization and testosterone for masculinization. Estrogen use in cisgender women is associated with well-established changes in hemostatic parameters, including increases in prothrombotic factors and decreases in inhibitors of coagulation. Cisgender women using estrogen have an increased risk of thrombosis. Studies of thrombosis risk associated with estrogen GAHT in TG people are less robust, with some studies limited by the use of hormones and hormone management strategies that are no longer recommended. However, TG women using estrogen appear to be at increased risk of both arterial and venous thrombosis, which may increase with longer time on estrogen. Testosterone use in both cisgender and transgender men is associated with increases in hemoglobin and hematocrit, which can lead to erythrocytosis and thus increased risk of thrombosis. The results of studies evaluating thrombosis risk in the setting of testosterone use are mixed. This review presents an overview of alterations in hemostatic parameters and thrombosis risk associated with use of exogenous estrogen and testosterone. Understanding what is known and unknown about thrombosis risk associated with use of these hormones is essential for hematologists who may be asked to evaluate TG people and provide guidance on management of those who may be at increased risk of thrombosis.
跨性别和性别扩张（TG）者——那些认同自己出生时被指定的性别以外的性别的人——经常经历性别焦虑，这与负面的健康结果有关。改善性别焦虑的一个关键策略是使用性别肯定激素治疗（GAHT）：雌激素用于女性化，睾丸激素用于男性化。顺性别女性使用雌激素会引起止血参数的明确变化，包括促血栓形成因素增加和凝血抑制剂减少。使用雌激素的顺性别女性有更高的血栓形成风险。关于 TG 人群中雌激素 GAHT 相关血栓形成风险的研究则不那么可靠，有些研究受到激素使用和不再推荐的激素管理策略的限制。然而，使用雌激素的 TG 女性似乎有更高的动脉和静脉血栓形成风险，而且随着雌激素使用时间的延长，风险可能会增加。顺性别和跨性别男性使用睾丸激素会导致血红蛋白和血细胞比容增加，从而导致红细胞增多症，进而增加血栓形成的风险。评估睾丸激素使用时血栓形成风险的研究结果存在差异。本综述介绍了使用外源性雌激素和睾丸激素引起的止血参数改变和血栓形成风险。了解关于使用这些激素与血栓形成风险相关的已知和未知信息，对于可能被要求评估 TG 人群并为那些可能有更高血栓形成风险的人提供管理指导的血液科医生至关重要。
