da Cruz Paloma Dias, Santos Betânia Rodrigues, Spritzer Poli Mara
Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul (RS), Brazil.
Post-Graduate Program in Endocrinology, Medicine School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
PLoS One. 2025 May 14;20(5):e0323606. doi: 10.1371/journal.pone.0323606. eCollection 2025.
Transgender women have an increased incidence of venous thromboembolism (VTE) compared with cisgender individuals. However, data on hemostatic parameters in this population are scarce. We aimed to evaluate hemostatic parameters in transgender women receiving gender-affirming hormone therapy (GAHT) compared with cisgender controls. We conducted a cross-sectional study including 40 transgender women (sample size based on prior calculation), and age- and body mass index-matched cisgender women (n = 25) and cisgender men (n = 25) as controls. Blood samples were collected between 2016 and 2023. We assessed hemostatic parameters (plasminogen activator inhibitor-1 [PAI-1], free protein S, vascular cell adhesion molecule-1, antithrombin, anticoagulant protein C, prothrombin time activity, thrombin time), hormonal profile (estradiol, sex hormone-binding globulin, estrogen dose, total testosterone, and free androgen index), and inflammatory markers (fibrinogen, C-reactive protein, and leukocyte count). Transgender women (mean [SD] age, 30.6 [8.0] years; median GAHT duration, 36.5 months) and cisgender women had similar hemostatic and inflammatory parameters. Compared with cisgender men, transgender women had higher PAI-1 levels (p = 0.001) and lower free protein S levels (p = 0.023). No differences were found in other hemostatic parameters between the groups. In conclusion, transgender women on long-term GAHT had higher levels of PAI-1 and lower levels of free protein S than cisgender men, indicating a slightly more prothrombotic profile. However, their hemostatic and inflammatory parameters were similar to those of cisgender women, suggesting a shift towards a female pattern. Factors beyond GAHT may contribute to the increased risk of VTE in this population.
与顺性别者相比， transgender女性静脉血栓栓塞（VTE）的发病率更高。然而，关于该人群止血参数的数据却很稀少。我们旨在评估接受性别确认激素疗法（GAHT）的transgender女性与顺性别对照者的止血参数。我们进行了一项横断面研究，纳入了40名transgender女性（样本量基于先前计算），以及年龄和体重指数匹配的顺性别女性（n = 25）和顺性别男性（n = 25）作为对照。在2016年至2023年期间采集血样。我们评估了止血参数（纤溶酶原激活物抑制剂-1 [PAI-1]、游离蛋白S、血管细胞粘附分子-1、抗凝血酶、抗凝蛋白C、凝血酶原时间活性、凝血酶时间）、激素谱（雌二醇、性激素结合球蛋白、雌激素剂量、总睾酮和游离雄激素指数）以及炎症标志物（纤维蛋白原、C反应蛋白和白细胞计数）。transgender女性（平均[标准差]年龄，30.6 [8.0]岁；GAHT持续时间中位数，36.5个月）和顺性别女性的止血和炎症参数相似。与顺性别男性相比，transgender女性的PAI-1水平更高（p = 0.001），游离蛋白S水平更低（p = 0.023）。两组之间的其他止血参数未发现差异。总之，长期接受GAHT的transgender女性比顺性别男性的PAI-1水平更高，游离蛋白S水平更低，表明其血栓形成倾向略高。然而，她们的止血和炎症参数与顺性别女性相似，表明向女性模式转变。GAHT以外的因素可能导致该人群VTE风险增加。
