Assessing the risk of venous thromboembolism in trans masculine persons on gender-affirming hormone therapy: A literature review.

Most recent large-scale studies have not found a statistically significant change in VTE risk in trans masculine persons on testosterone therapy.

• Review performed via electronic search in MEDLINE/PubMed without date restrictions
• Eligible articles were peer-reviewed observational and interventional studies written in English
• Results were synthesized by theme of analysis
• The absence of significant VTE risk increase was the predominant finding across large-scale studies

Available data on VTE risk in trans masculine persons on testosterone are predominantly derived from younger individuals with minimal cardiovascular risk factors.

• The generalizability of current findings is limited by the demographic characteristics of study populations
• Most studies did not include individuals with higher VTE risk profiles
• Further robust studies are warranted to generalize results to higher venous thromboembolic risk groups

For trans masculine patients with a personal or family history of VTE, initiation of testosterone therapy requires multidisciplinary evaluation balancing risk-benefit ratio.

• Discussion within a multidisciplinary team specializing in transgender health is recommended for higher-risk patients
• The risk of suicide is noted to be high in this population and is largely reduced by gender-affirming hormone therapy
• The risk-benefit balance must account for the mental health benefits of gender-affirming hormone therapy alongside VTE risk

Current evidence on VTE risk in trans masculine persons on testosterone is limited and warrants further investigation.

• Data are described as limited across the reviewed literature
• Further robust studies are warranted to clarify these data
• Generalization of results to higher venous thromboembolic risk groups is not yet supported by existing evidence