Review of venous thromboembolism (VTE) risk, evaluation, and treatment in individuals on estrogen-based gender-affirming hormone therapy.

Transgender women on estrogen-based gender-affirming hormone therapy experience higher rates of VTE compared to cisgender peers.

• Epidemiological studies consistently demonstrate elevated VTE rates in this population.
• Multiple factors are identified as contributing to increased risk, including medication use, comorbidities, and social determinants of health.
• The review synthesizes current evidence across both transgender and cisgender populations using estrogen.

Estrogen-based gender-affirming hormone therapy is associated with increased risk of venous thromboembolism.

• The review examines various forms of estrogen used in gender-affirming hormone therapy.
• Evidence is drawn from studies of both transgender individuals and cisgender individuals using estrogen.
• The prothrombotic effects of estrogen are identified as a contributing mechanism to elevated VTE risk.

Social determinants of health contribute to elevated VTE risk in transgender women.

• Social determinants of health are identified alongside medication use and comorbidities as risk factors.
• These factors are described as likely increasing VTE risk in this population.
• The review highlights the multifactorial nature of VTE risk beyond pharmacological factors alone.

The review discusses strategies for managing VTE and reducing risk in patients using estrogen-based gender-affirming hormone therapy.

• The article addresses both treatment strategies for VTE occurring in patients on estrogen-based gender-affirming hormone therapy and methods to reduce VTE risk.
• Management considerations are discussed in the context of patients for whom estrogen therapy is critical for addressing unwanted secondary sexual characteristics.
• The review acknowledges the importance of balancing VTE risk reduction with the critical role of gender-affirming hormone therapy for patients' wellbeing.