King Hannah, Kelley Thalia Padilla, Shatzel Joseph J
Department of Internal Medicine, Oregon Health & Science University, Portland, OR.
Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR.
Hematology Am Soc Hematol Educ Program. 2024 Dec 6;2024(1):652-663. doi: 10.1182/hematology.2024000592.
Research regarding the hematologic sequelae of estrogen and testosterone therapy for transgender people is an emerging area. While estrogen therapy has been widely studied in cisgender women, studies in transgender individuals are limited, revealing variable adverse effects influenced by the dose and formulation of estrogen used. Thrombotic risk factors in transgender and gender-diverse individuals are multifactorial, involving both modifiable and nonmodifiable factors. Management of venous thromboembolism (VTE) in individuals receiving gender-affirming estrogen entails standard anticoagulation therapy alongside shared decision-making regarding hormone continuation and risk factor modification. While data and guidance from cisgender women can offer a reference for managing thrombotic risk in transgender individuals on hormone therapy, fully applying these insights can be challenging. The benefits of gender-affirming hormone therapy include significantly reducing the risk of suicide and depression, highlighting the importance of a contemplative approach to the management of hormonal therapy after a VTE event. Although limited, the available data in the literature indicate a low thrombotic risk for transgender individuals undergoing gender-affirming testosterone therapy. However, polycythemia is a common adverse effect necessitating monitoring and, occasionally, adjustments to hormonal therapy. Additionally, iron deficiency may arise due to the physiological effects of testosterone or health care providers' use of phlebotomy, an aspect that remains unstudied in this population. In conclusion, while the set of clinical data is expanding, further research remains vital to refine management strategies and improve hematologic outcomes for transgender individuals undergoing gender-affirming hormone therapy.
关于变性人雌激素和睾酮治疗血液学后遗症的研究是一个新兴领域。虽然雌激素治疗在顺性别女性中已得到广泛研究，但针对变性人的研究有限，显示出受所用雌激素剂量和剂型影响的不良反应各不相同。变性人和性别多样化个体的血栓形成危险因素是多因素的，涉及可改变和不可改变的因素。接受性别肯定性雌激素治疗的个体发生静脉血栓栓塞（VTE）的管理需要标准抗凝治疗以及关于激素继续使用和危险因素改变的共同决策。虽然来自顺性别女性的数据和指导可为激素治疗的变性人管理血栓形成风险提供参考，但完全应用这些见解可能具有挑战性。性别肯定性激素治疗的益处包括显著降低自杀和抑郁风险，凸显了在VTE事件后对激素治疗管理采取审慎方法的重要性。尽管有限，但文献中的现有数据表明，接受性别肯定性睾酮治疗的变性人血栓形成风险较低。然而，红细胞增多症是一种常见的不良反应，需要进行监测，偶尔还需调整激素治疗。此外，由于睾酮的生理作用或医疗保健提供者使用放血疗法，可能会出现缺铁，这在该人群中仍是一个未被研究的方面。总之，虽然临床数据在不断增加，但进一步的研究对于完善管理策略和改善接受性别肯定性激素治疗的变性人的血液学结果仍然至关重要。
