Venous Thromboembolism and Estrogen-Containing Gender-Affirming Hormone Therapy.

VTE is thought to affect up to 5% of transgender women using estrogen-containing gender-affirming hormone therapy.

• Historical GAHT was associated with a high risk of VTE compared to modern preparations.
• Modern preparations are considered less thrombogenic 'mainly due to significantly lower doses used as well as different preparations.'
• The evidence of VTE risk among transgender women using modern GAHT is described as 'still emerging.'

Route of administration of estradiol affects VTE risk in transgender women receiving GAHT.

• The review specifically examines how different routes of estradiol administration differentially affect thrombotic risk.
• Oral estrogen preparations are generally considered more thrombogenic than transdermal preparations due to first-pass hepatic metabolism.
• This topic was identified as one of the four key areas addressed in the review.

Perioperative management of gender-affirming hormone therapy requires specific consideration with respect to VTE risk.

• Perioperative management of GAHT was identified as one of four key clinical topics reviewed.
• The review presents available literature on how to manage GAHT in the surgical/perioperative setting.
• The perioperative period is a recognized time of elevated VTE risk that may interact with estrogen-containing GAHT.

VTE risk among adolescents on gender-affirming hormone therapy is a distinct area of clinical concern addressed in the review.

• Adolescent VTE risk on GAHT was identified as one of the four key topics covered.
• The review presents available literature specific to this younger population.
• Age is identified as one of the factors that may affect VTE risk characterization in future longitudinal studies.

Multiple patient-level factors are recognized as potentially modifying VTE risk in transgender women using GAHT but remain incompletely characterized.

• Factors identified as needing further study include patient age, duration of GAHT use, tobacco use, body mass index, and comorbidities.
• The authors state there is 'a need for large, longitudinal studies of transgender women using GAHT to further characterize VTE risk.'
• Current evidence is insufficient to fully inform clinical guidelines for the care of transgender people regarding VTE risk management.