Review of venous thromboembolism (VTE) risk, evaluation, and treatment in individuals on estrogen-based gender-affirming hormone therapy.

Epidemiological studies of transgender women suggest that these individuals experience higher rates of venous thromboembolism than their cisgender peers. Several factors likely increase this risk, including medication use, comorbidities, and social determinants of health. Estrogen-based gender-affirming hormone therapy is critical for helping patients address unwanted secondary sexual characteristics and induce physical changes in accordance with their gender identity. However, the use of estrogen-based gender-affirming hormone therapy may increase the risk of venous thromboembolism. This review article summarizes the current evidence describing venous thromboembolism risk among patients using various forms of estrogen, including transgender and cisgender individuals. The article also discusses strategies for managing venous thromboembolism in patients using estrogen-based gender-affirming hormone therapy and methods to reduce venous thromboembolism risk.