Estrogen Continuation and Venous Thromboembolism in Penile Inversion Vaginoplasty

Nolan, Ian T; Haley, Caleb; Morrison, Shane D; Pannucci, Christopher J.; Satterwhite, Thomas

doi:10.1016/j.jsxm.2020.10.018

Cited by 17 publications

(9 citation statements)

References 26 publications

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“…811 papers were excluded as irrelevant, based on title and abstract reading. Hence, as shown in Figure 1, 99 studies were identified, of which 18 met the inclusion criteria (17,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49). The studies by Asscheman and colleagues published in 1989 (50) and 2011 (51) were excluded since the population under investigation was already included in the paper by van Kesteren et al, 1997 (47).…”

Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

Risk of Venous Thromboembolism in Transgender People Undergoing Hormone Feminizing Therapy: A Prevalence Meta-Analysis and Meta-Regression Study

et al. 2021

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BackgroundAlthough venous thromboembolism (VTE) is a recognized side effect of some formulations of estrogen therapy, its impact in transgender people remains uncertain. The aim of this study was to define pooled prevalence estimate and correlates of VTE in Assigned Males at Birth (AMAB) trans people undergoing gender affirming hormone therapy.MethodsA thorough search of MEDLINE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases was carried out to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effects models and the between-study heterogeneity was assessed by the Cochrane’s Q and I2.ResultsThe eighteen studies included gave information about 11,542 AMAB undergoing gender affirming hormone therapy. The pooled prevalence of VTE was 2% (95%CI:1-3%), with a large heterogeneity (I2 = 89.18%, P<0.0001). Trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimate. At the meta-regression analysis, a higher prevalence of VTE was significantly associated with an older age (S=0.0063; 95%CI:0.0022,0.0104, P=0.0027) and a longer length of estrogen therapy (S=0.0011; 95%CI:0.0006,0.0016, P<0.0001). When, according to the meta-regression results, the analysis was restricted to series with a mean age ≥37.5 years, the prevalence estimate for VTE increased up to 3% (95%CI:0-5%), but with persistence of a large heterogeneity (I2 = 88,2%, P<0.0001); studies on younger participants (<37.5 years) collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-2%) with no heterogeneity (I2 = 0%, P=0.97). Prevalence estimate for VTE in series with a mean length of estrogen therapy ≥53 months was 1% (95%CI:0-3%), with persistent significant heterogeneity (I2 = 84,8%, P=0.0006); studies on participants subjected to a shorter length of estrogen therapy (<53 months), collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-3%) with no heterogeneity (I2 = 0%, P=0.76).ConclusionsThe overall rate of VTE in AMAB trans people undergoing gender affirming hormone therapy was 2%. In AMAB population with <37.5 years undergoing estrogen therapy for less than 53 months, the risk of VTE appears to be negligible. Further studies are warranted to assess whether different types and administration routes of estrogen therapy could decrease the VTE risk in AMAB trans people over 37.5 years subjected to long-term therapy.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021229916].

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Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

Risk of Venous Thromboembolism in Transgender People Undergoing Hormone Feminizing Therapy: A Prevalence Meta-Analysis and Meta-Regression Study

et al. 2021

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“…In addition, a prospective cohort study of patients undergoing PIV from 2014 to 2018 found continuing estrogen therapy throughout the perioperative period for penile inversion vaginoplasty did not significantly increase the risk of VTE 9,14 . However, the authors of this study note many patients had a low Caprini score at baseline 9,14 . Testosterone theoretically increases cardiovascular risk in the perioperative period, but this has not been observed in masculine patients 11 .…”

Section: Perioperative Hormone Managementmentioning

confidence: 72%

“…Retrospective review on complications after penile inversion vaginoplasty suggest that hormone replacement therapy use, age, and BMI should not be the sole factors dictating time for surgery as they are not associated with complications 13 . In addition, a prospective cohort study of patients undergoing PIV from 2014 to 2018 found continuing estrogen therapy throughout the perioperative period for penile inversion vaginoplasty did not significantly increase the risk of VTE 9,14 . However, the authors of this study note many patients had a low Caprini score at baseline 9,14 .…”

Section: Perioperative Hormone Managementmentioning

confidence: 77%

“…9,14 However, the authors of this study note many patients had a low Caprini score at baseline. 9,14 Testosterone theoretically increases cardiovascular risk in the perioperative period, but this has not been observed in masculine patients. 11 There is currently no data to suggest increased VTE risk with testosterone use.…”

Section: Perioperative Hormone Managementmentioning

confidence: 99%

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Beyond the Binary: Considerations About Gender-affirming Care for the General Surgeon

Agbafe

Lane²,

Sheetz³

et al. 2021

Annals of Surgery

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“…10 Moreover, controversies regarding perioperative hormone management, hair removal, dilation regimens, and general postoperative management persist. 11–14…”

Section: Introductionmentioning

confidence: 99%

Gender-Affirming Vaginoplasty: A Comparison of Algorithms, Surgical Techniques and Management Practices across 17 High-volume Centers in North America and Europe

Coon

Morrison

Morris

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Penile inversion vaginoplasty is the most common gender-affirming genital surgery performed around the world. Although individual centers have published their experiences, expert consensus is generally lacking. Methods: Semistructured interviews were performed with 17 experienced gender surgeons representing a diverse mix of specialties, experience, and countries regarding their patient selection, preoperative management, vaginoplasty techniques, complication management, and postoperative protocols. Results: There is significant consistency in practices across some aspects of vaginoplasty. However, key areas of clinical heterogeneity are also present and include use of extragenital tissue for vaginal canal/apex creation, creation of the clitoral hood and inner labia minora, elevation of the neoclitoral neurovascular bundle, and perioperative hormone management. Pathway length of stay is highly variable (1–9 days). Lastly, some surgeons are moving toward continuation or partial reduction of estrogen in the perioperative period instead of cessation. Conclusions: With a broad study of surgeon practices, and encompassing most of the high-volume vaginoplasty centers in Europe and North America, we found key areas of practice variation that represent areas of priority for future research to address. Further multi-institutional and prospective studies that incorporate patient-reported outcomes are necessary to further our understanding of these procedures.

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Estrogen Continuation and Venous Thromboembolism in Penile Inversion Vaginoplasty

Cited by 17 publications

References 26 publications

Risk of Venous Thromboembolism in Transgender People Undergoing Hormone Feminizing Therapy: A Prevalence Meta-Analysis and Meta-Regression Study

Risk of Venous Thromboembolism in Transgender People Undergoing Hormone Feminizing Therapy: A Prevalence Meta-Analysis and Meta-Regression Study

Beyond the Binary: Considerations About Gender-affirming Care for the General Surgeon

Gender-Affirming Vaginoplasty: A Comparison of Algorithms, Surgical Techniques and Management Practices across 17 High-volume Centers in North America and Europe

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