Genital Surgery Outcomes Using an Individualized Algorithm for Hormone Management in Transfeminine Individuals.

The majority of transfeminine individuals undergoing genital surgery continued estradiol perioperatively under an individualized hormone management algorithm.

• 138 of 183 individuals (75.4%) continued estradiol perioperatively (Group 1)
• 45 of 183 individuals (24.6%) temporarily held estradiol preoperatively (Group 2)
• Study was a retrospective observational cohort at a single tertiary referral center from 2017 to 2022
• Total cohort size was 183 transfeminine individuals

Individuals who temporarily held estradiol preoperatively were statistically older and had higher cardiometabolic comorbidity burden compared to those who continued estradiol.

• Group 2 (held estradiol) was statistically older than Group 1 (P < .01)
• Group 2 had higher incidence of cardiometabolic comorbidities (P < .01)
• Group 2 had higher Caprini scores (P < .01), indicating greater VTE risk
• Group 1 was statistically more likely to use oral estradiol (P < .01)

The incidence of venous thromboembolism (VTE) was very low, with only one episode occurring across the entire cohort.

• One episode of VTE occurred, representing 0.05% of the cohort
• The single VTE event occurred in Group 1 (the estradiol continuation group)
• No VTE events occurred in Group 2 (the estradiol discontinuation group)
• There was no significant difference in VTE incidence between groups

There was no significant difference in non-VTE postoperative complications between those who continued and those who temporarily discontinued estradiol.

• Postoperative complication incidence did not differ significantly between Group 1 and Group 2
• Both surgical complication and VTE outcomes were assessed as main outcomes
• The individualized algorithm assigned higher-risk patients (older, more comorbidities) to the estradiol discontinuation group
• Despite this risk stratification, complication rates were comparable between groups

Behavioral health measures remained stable perioperatively and did not differ significantly between those who continued versus discontinued estradiol.

• Validated behavioral health measures were collected pre- and postoperatively
• There was no significant difference in behavioral health assessment changes between Group 1 and Group 2
• Behavioral health stability was maintained even in patients who temporarily discontinued estradiol for 2 to 6 weeks preoperatively
• Behavioral health outcomes were included as a main outcome measure of the study

The individualized algorithm was based on risk factor assessment and resulted in temporary estradiol discontinuation for 2 to 6 weeks preoperatively only for higher-risk patients.

• The algorithm individualized hormone management based on patient-specific risk factors rather than applying a uniform preoperative discontinuation protocol
• Estradiol was temporarily held for 2 to 6 weeks preoperatively in Group 2
• Patients grouped into the discontinuation group had higher Caprini scores and higher cardiometabolic comorbidity rates
• The algorithm was implemented at a single tertiary referral center with interdisciplinary gender-affirming providers