Association of Surgical Risk With Exogenous Hormone Use in Transgender Patients

December 2018 in “ JAMA Surgery ”

Elizabeth R. Boskey, Amir H. Taghinia, Oren Ganor

testosterone spironolactone estrogen cross-sex hormone treatment CSHT venous thromboembolism VTE transdermal estrogens oral estrogens hormone therapy blood clots

TLDR Hormone treatment for transgender patients may not need to be stopped before surgery, but more research is needed, especially on estrogen.

The systematic review by Boskey et al. from 2019 analyzed 18 articles to evaluate the perioperative risks associated with cross-sex hormone treatment (CSHT) in transgender patients. The review found limited data suggesting that exogenous testosterone does not significantly increase the risk of venous thromboembolism (VTE) or other complications during surgery. Moderate evidence indicated that spironolactone does not lead to negative surgical outcomes. However, the evidence on estrogen use was inconsistent, particularly regarding the types of estrogens used in CSHT. The review concluded that there is not enough evidence to support the routine discontinuation of CSHT prior to surgery, especially for testosterone and spironolactone. While oral estrogens have been linked to an increased risk of thrombosis, the necessity of stopping transdermal estrogens before surgery is not clear. Further research is needed to evaluate the safety of continuing hormone treatment and the risks associated with short-term discontinuation. Historical studies showed an increased risk of VTE with hormone use, but more recent studies have mixed results, and perioperative management recommendations vary.

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Hormone treatment for transgender patients may not need to be stopped before surgery, but more research is needed, especially on estrogen.

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