Transgender patients and the role of the coagulation clinician
Open accessAbstract
The medical care of transgender patients relies on the use of sex hormones to develop and maintain the physical characteristics consistent with gender identity as the first step in transitioning. Hormonal therapy is usually continued indefinitely, even following gender-affirming surgeries. The use of hormonal treatments is associated with a multitude of positive effects as well as complications and side effects. The risk of venous thromboembolism (VTE) is a major concern. Transgender patients are often referred to coagulation specialists for advice regarding an individual patient's risk for VTE, especially if there is a personal or family history of VTE. Coagulation specialists need to be familiar with endocrine therapy including the goals of treatment and the VTE risks associated with currently used hormone regimens. We will review common referral questions and the available data and their limitations for the use of hormonal therapy in transgender patients focusing on the risk of VTE.
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In the US, most transwomen are treated with either oral or transdermal estradiol in association with spironolactone.
“In the US, most transwomen are treated with either oral or transdermal estradiol in association with spironolactone [116].”
From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [116]
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Estrogen and thrombosis: a bench to bedside review
Abou-Ismail, M. Y., Citla Sridhar, D., & Nayak, L. (2020) · Thrombosis Research · doi:10.1016/j.thromres.2020.05.008 · Cited by 261 · see citing works
- Authors
- Connors, J. M., & Middeldorp, S.
- Affiliations
- Brigham and Women's Hospital (US)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Connors, Jean M.
- Venue
- Journal of Thrombosis and Haemostasis
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 17
- Issue
- 11
- Pages
- 1790-1797
- ISSN
- 1538-7836 (ISSN-L)
- OpenAlex
- W2970850359
- Cited by
- 42
- References
- 61
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 7 · 2023: 10 · 2022: 8 · 2021: 3 · 2020: 6
- FWCI
- 1.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Pfizer
- CSL Behring
- Unum Therapeutics
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Health Sciences › Medicine › Neurology › Cerebral Venous Sinus Thrombosis
- Keywords
- transgender patients, sex hormones, hormone therapy, gender-affirming surgery, venous thromboembolism, VTE risk, endocrine therapy, anticoagulation
- MeSH terms
- Adult, Attitude of Health Personnel, Blood Coagulation, Clinical Competence, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Patient Education as Topic, Physician-Patient Relations, Physician's Role, Risk Factors, Gonadal Steroid Hormones, Thromboembolism, Transsexualism, Health Behavior, Risk Assessment, Young Adult, Gender-Affirming Procedures, Transgender Persons
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