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      Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons : A Cohort Study

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          Abstract

          Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use.

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          Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline

          Wylie Hembree, Peggy Cohen-Kettenis, Louis J.G. Gooren … (2017)
          To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009.
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            Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes.

            Victor Montori, Susana Garcia, Rebecca Mullan … (2010)
            To assess the prognosis of individuals with gender identity disorder (GID) receiving hormonal therapy as a part of sex reassignment in terms of quality of life and other self-reported psychosocial outcomes. We searched electronic databases, bibliography of included studies and expert files. All study designs were included with no language restrictions. Reviewers working independently and in pairs selected studies using predetermined inclusion and exclusion criteria, extracted outcome and quality data. We used a random-effects meta-analysis to pool proportions and estimate the 95% confidence intervals (CIs). We estimated the proportion of between-study heterogeneity not attributable to chance using the I(2) statistic. We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%). Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.
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              Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study.

              Marianne Canonico, Emmanuel Oger, Geneviève Plu-Bureau … (2007)
              Oral estrogen therapy increases the risk of venous thromboembolism (VTE) in postmenopausal women. Transdermal estrogen may be safer. However, currently available data have limited the ability to investigate the wide variety of types of progestogen. We performed a multicenter case-control study of VTE among postmenopausal women 45 to 70 years of age between 1999 and 2005 in France. We recruited 271 consecutive cases with a first documented episode of idiopathic VTE (208 hospital cases, 63 outpatient cases) and 610 controls (426 hospital controls, 184 community controls) matched for center, age, and admission date. After adjustment for potential confounding factors, odds ratios (ORs) for VTE in current users of oral and transdermal estrogen compared with nonusers were 4.2 (95% CI, 1.5 to 11.6) and 0.9 (95% CI, 0.4 to 2.1), respectively. There was no significant association of VTE with micronized progesterone and pregnane derivatives (OR, 0.7; 95% CI, 0.3 to 1.9 and OR, 0.9; 95% CI, 0.4 to 2.3, respectively). In contrast, norpregnane derivatives were associated with a 4-fold-increased VTE risk (OR, 3.9; 95% CI, 1.5 to 10.0). Oral but not transdermal estrogen is associated with an increased VTE risk. In addition, our data suggest that norpregnane derivatives may be thrombogenic, whereas micronized progesterone and pregnane derivatives appear safe with respect to thrombotic risk. If confirmed, these findings could benefit women in the management of their menopausal symptoms with respect to the VTE risk associated with oral estrogen and use of progestogens.
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                Author and article information

                Journal
                Title: Annals of Internal Medicine
                Abbreviated Title: Ann Intern Med
                Publisher: American College of Physicians
                ISSN (Print): 0003-4819
                Publication date (Electronic): July 10 2018
                Affiliations
                [1 ]Kaiser Permanente Southern California, Pasadena, California (D.G., T.A.B., V.P.Q.)
                [2 ]Emory University, Atlanta, Georgia (R.N., W.D.F., T.L.L., M.G.)
                [3 ]Kaiser Permanente Los Angeles Medical Center, Los Angeles, California (T.C.B.)
                [4 ]Kaiser Permanente Georgia, Atlanta, Georgia (L.C., B.R.)
                [5 ]Kaiser Permanente Northern California, Oakland, California (E.H., A.M., M.J.S., J.S.)
                [6 ]Kaiser Permanente Mid-Atlantic States, Rockville, Maryland (D.R.)
                [7 ]Icahn School of Medicine at Mount Sinai, New York, New York (J.S.)
                [8 ]Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia (V.T.)
                Article
                DOI: 10.7326/M17-2785
                PMC ID: 6636681
                PubMed ID: 29987313
                SO-VID: 6c9d7bed-64c4-4c00-bb90-3241257e95d1
                Copyright © © 2018
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