Gender-Affirming Hormone Therapy for Transgender Females

    September 2018 in “ Clinical Obstetrics and Gynecology ”
    John F. Randolph
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    TLDR Hormone therapy for transgender females increases the risk of blood clots and requires careful dosing, monitoring, and lifelong management.
    The 2018 document outlines the use of hormone therapy for transgender females, detailing the feminizing effects of estrogens and antiandrogens, and the associated risks, particularly venous thromboembolism (VTE). It reports a 4.1-fold and 3.4-fold increased risk of VTE in transgender women compared to cisgender men and women, respectively, after 2 years of therapy. The document highlights the importance of individualized dosing, ongoing monitoring, and standard cancer screening. It also discusses the physical changes induced by hormone therapy, such as breast growth and body fat redistribution, and the process of starting therapy, including informed consent and medical assessment. Various hormone regimens are presented, with a focus on monitoring for thrombotic events and the need for life-long hormone therapy with annual screenings. Special considerations are recommended for transwomen with increased thrombotic risk or cancer risk, advocating for nonoral administration of estrogens to reduce thrombotic risk.
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