Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons

Getahun, Darios; Nash, Rebecca; Flanders, W. Dana; Baird, Tisha C.; Becerra-Culqui, Tracy A.; Cromwell, Lee; Hunkeler, Enid M.; Lash, Timothy L.; Millman, Andrea; Quinn, Virginia P.; Robinson, Brandi; Roblin, Douglas W.; Silverberg, Michael J.; Safer, Joshua D.; Slovis, Jennifer; Tangpricha, Vin; Goodman, Michael

doi:10.7326/m17-2785

Cited by 319 publications

(309 citation statements)

References 32 publications

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“…This large cohort study compared the incidence of VTE, stroke, and myocardial infarction in 2842 transwomen and 2118 transmen over a 4-year period and matched non-transgender cases at a 10:1 ratio with reference populations of 48 686 cismen and 48 775 ciswomen. 5 17,25,26 Transwomen using estrogens also had an increase in risk of ischemic stroke in this study that was most pronounced after 6 years of use and continued to increase over time, similar to VTE risk. Before 6 years of estrogen use the HR for ischemic stroke was 1.3 (0.6-2.9)…”

Section: Vte Risks With Mtf Hormonal Therapysupporting

confidence: 51%

“…A large database analysis of U.S. patients in an integrated managed care consortium suggests that the risks associated with hormone therapy may be different when used by transwomen than by postmenopausal ciswomen. This large cohort study compared the incidence of VTE, stroke, and myocardial infarction in 2842 transwomen and 2118 transmen over a 4‐year period and matched non‐transgender cases at a 10:1 ratio with reference populations of 48 686 cismen and 48 775 ciswomen . Cases were matched for BMI, smoking history, hypertension, and cholesterol values.…”

Section: Case I: Mtfmentioning

confidence: 99%

“…The patient felt that the risk of VTE associated with using estradiol was acceptable. She was informed that the risk of VTE may increase after 2 years of use, on the basis of limited data . She was advised to stop smoking.…”

Section: Case I: Mtfmentioning

confidence: 99%

“…A subsequent larger randomized trial had such low numbers of cardiovascular events in each arm that rates could not be determined . In the U.S. database study of transmen, results for ischemic stroke with versus without testosterone use were 1.1 (CI, 0.6‐2.0) and 1.3 (CI, 0.7‐2.5), and 0.7 (CI, 0.3‐1.8) and 1.3 (CI, 0.5‐3.9) for myocardial infarction . In transmen initiating testosterone the number of events was too low to determine incidence and HR for these outcomes.…”

Section: Case Iii: Ftmmentioning

confidence: 99%

“…She was informed that the risk of VTE may increase after 2 years of use, on the basis of limited data. 5 She was advised to stop smoking. Age-associated VTE risk was also reviewed, 42 and signs and symptoms of VTE were discussed.…”

Section: Thrombophilia Testing In Mtfmentioning

confidence: 99%

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Transgender patients and the role of the coagulation clinician

Connors

2019

Journal of Thrombosis and Haemostasis

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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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Section: Vte Risks With Mtf Hormonal Therapysupporting

confidence: 51%

Section: Case I: Mtfmentioning

confidence: 99%

Section: Case I: Mtfmentioning

confidence: 99%

Section: Case Iii: Ftmmentioning

confidence: 99%

Section: Thrombophilia Testing In Mtfmentioning

confidence: 99%

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Transgender patients and the role of the coagulation clinician

Connors

2019

Journal of Thrombosis and Haemostasis

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Acute Clinical Care for Transgender Patients

et al. 2018

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IMPORTANCETransgender is an umbrella term used to describe individuals whose gender identity and/or gender expression differs from assigned sex at birth. There are an estimated 1.4 million transgender adults in the United States, and this number is increasing. Clinicians will increasingly be caring for transgender patients. Topics considered in this narrative review include terminology, how to address transgender patients, obtaining an inclusive history that takes into account gender-affirming surgery, managing hormone therapy and other clinical issues, consideration for hospitalized patients, interpreting laboratory values in the setting of hormone use, legal issues, and considerations for health systems.OBSERVATIONS Best practices in caring for a transgender patient include using a patient-identified name and pronoun, using gender-neutral terminology until the appropriate term is identified by the patient, and obtaining a surgical history inclusive of an anatomic inventory. Gender-affirming hormones can modify disease-specific risk factors or confer risk for in-hospital complications. They can also cause changes in laboratory values; however, studies are limited to observational studies and case series. Some data are derived and extrapolated from cisgender populations. There are also unique systems-based concerns, including lack of procedures for standardized collection of gender identity and lack of sufficiently comprehensive electronic health record platforms. Vulnerabilities exist for hospitalized transgender patients in the transition from the inpatient to outpatient care that require dedicated institutional efforts to address. CONCLUSIONS AND RELEVANCEClinicians should learn how to engage with transgender patients, appreciate that unique anatomy or the use of gender-affirming hormones may affect the prevalence of certain disease (eg, cardiovascular disease, venous thromboembolism, and osteoporosis), and be prepared to manage specific issues, including those related to hormone therapy. Health care facilities should work toward providing inclusive systems of care that correctly identify and integrate information about transgender patients into the electronic health record, account for the unique needs of these patients within the facility, and through education and policy create a welcoming environment for their care.

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Sexual and Gender Minority Health in Neurology

et al. 2021

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ittle is known about the neurologic health needs of sexual and gender minority (SGM) individuals (ie, those in the lesbian, gay, bisexual, transgender, and queer [LGBTQ+] spectrum). Understanding an individual's identity is essential for patientcentered communication, which improves patient satisfaction and reduces health disparities. SGM identity directly impacts a variety of neurologic conditions, including epilepsy, 1 dementia, 2 and stroke. 3,4 Neurologists receive little to no dedicated SGM health training, 5 which may lead to conscious or unconscious behaviors that contribute to existing disparities. 6 A 2018 study 3 of US neurologists, for example, found that while most reported comfort in caring for SGM individuals, fewer demonstrated SGM-related medical knowledge. Nearly half of respondents believed that sexual orientation and gender identity had no bearing on the management of neurologic illness. 3 This scoping review seeks to describe the cur-rent state of science in SGM health in neurology to highlight areas of knowledge and gaps to inform future research. MethodsGuided by an experienced medical librarian (E.W.), we developed, tested, and finalized a PubMed search using medical subject headings and keywords with SGM descriptors 7 and neurologic disorders (eAppendix 1 in the Supplement). The disorders were compiled based on clinical expertise, the National Institute of Neurologic Disorders and Stroke website, 8 and prior research. 9 This search was modified for Embase, Web of Science, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and BIOSIS Previews. IMPORTANCE Little is known about the neurologic health needs of sexual and gender minority (SGM) individuals, and existing research indicates health care disparities for this group. OBJECTIVE To describe the current state of science in SGM neurology and highlight areas of knowledge and gaps to guide future research.EVIDENCE REVIEW All articles published before April 12, 2020, in PubMed, Embase, Web of Science, PsycInfo, CINAHL, and BIOSIS Previews were searched using a search string encompassing SGM descriptors and neurologic disorders. A total of 8359 items were found and entered into EndNote, and 2921 duplicates were removed. A blind title and abstract review was performed followed by full-text review in duplicate, with conflicts settled through consensus, to identify 348 articles eligible for data abstraction. Articles presenting primary data about an identified adult SGM population addressing a clinical neurology topic were included. Descriptive statistics were used for abstracted variables.FINDINGS Of 348 studies, 205 (58.9%) were case reports or series, 252 (72.4%) included sexual minority cisgender men, and 247 (70.9%) focused on HIV. An association was found between autism spectrum disorder and gender dysphoria in 9 of 16 studies (56.3%), and a higher risk of ischemic stroke in transgender women was shown in other studies. Literature in neuroinfectious disease, the most common topic, largely focused on HIV (173 of 200...

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Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons

Abstract: Patient-Centered Outcomes Research Institute and Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Cited by 319 publications

References 32 publications

Transgender patients and the role of the coagulation clinician

Transgender patients and the role of the coagulation clinician

Acute Clinical Care for Transgender Patients

Sexual and Gender Minority Health in Neurology

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