Gender-affirming hormone therapy in the transgender patient: influence on thrombotic risk.

Thrombotic risk factors in transgender and gender-diverse individuals on estrogen therapy are multifactorial, involving both modifiable and nonmodifiable factors.

• Studies of estrogen therapy in transgender individuals are limited compared to cisgender women literature.
• Adverse thrombotic effects are influenced by the dose and formulation of estrogen used.
• Management of VTE entails standard anticoagulation therapy alongside shared decision-making regarding hormone continuation and risk factor modification.
• Data and guidance from cisgender women can offer a reference but cannot be fully applied to transgender individuals.

Gender-affirming hormone therapy provides significant mental health benefits, including reducing the risk of suicide and depression.

• The paper highlights that benefits of gender-affirming hormone therapy 'significantly reducing the risk of suicide and depression.'
• These benefits underscore 'the importance of a contemplative approach to the management of hormonal therapy after a VTE event.'
• The mental health benefits are cited as a reason not to discontinue hormone therapy reflexively following a VTE event.

Available data indicate a low thrombotic risk for transgender individuals undergoing gender-affirming testosterone therapy.

• The paper characterizes the available data as 'limited' but consistent in indicating low thrombotic risk.
• This finding is in contrast to the more established thrombotic risks associated with estrogen-based therapy.
• Further research is noted as necessary to refine management strategies.

Polycythemia is a common adverse effect of gender-affirming testosterone therapy, necessitating monitoring and occasional adjustments to hormonal therapy.

• Polycythemia is described as 'a common adverse effect' of testosterone therapy.
• Management may require 'adjustments to hormonal therapy' when polycythemia develops.
• Regular monitoring is indicated for individuals on testosterone therapy.

Iron deficiency may arise in transgender individuals on testosterone therapy due to physiological effects of testosterone or provider use of phlebotomy, and remains unstudied in this population.

• Iron deficiency can result from 'the physiological effects of testosterone' or from phlebotomy used to manage polycythemia.
• The paper explicitly states this is 'an aspect that remains unstudied in this population.'
• This represents a gap in the current literature identified by the authors.

Further research is needed to refine management strategies and improve hematologic outcomes for transgender individuals on gender-affirming hormone therapy.

• The authors state that 'the set of clinical data is expanding' but that 'further research remains vital.'
• Current guidance often relies on data extrapolated from cisgender populations, which may not fully apply.
• Both estrogen and testosterone therapy arms of transgender care are identified as needing additional study.