Incidence of Venous Thromboembolism in Transgender Women Receiving Oral Estradiol.
One of the most serious known adverse effects of feminizing cross-sex hormone therapy (CSHT) is venous thromboembolism (VTE); however, no study has assessed the incidence of VTE from the hormone therapies used in the United States because previous publications on this topic have originated in Europe. CSHT in the United States typically includes estradiol with the antiandrogen spironolactone, whereas in Europe estradiol is prescribed with the progestin cyproterone acetate.



To estimate the incidence of VTE from the standard feminizing CSHTs used in the United States.



A retrospective chart review of transgender women who had been prescribed oral estradiol at a District of Columbia community health center was performed.



The primary outcomes of interest were deep vein thrombosis or pulmonary emboli.



From January 1, 2008 through March 31, 2016, 676 transgender women received oral estradiol-based CSHT for a total of 1,286 years of hormone treatment and a mean of 1.9 years of CSHT per patient. Only one individual, or 0.15% of the population, sustained a VTE, for an incidence of 7.8 events per 10,000 person-years.



There was a low incidence of VTE in this population of transgender women receiving oral estradiol.
Whitman-Walker Health, Washington, DC, USA; The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: jarnold@gwu.edu.
Justin D
JD
Arnold
Whitman-Walker Health, Washington, DC, USA.
Eleanor P
EP
Sarkodie
Whitman-Walker Health, Washington, DC, USA.
Megan E
ME
Coleman
Whitman-Walker Health, Washington, DC, USA.
Deborah A
DA
Goldstein
D000284:Administration, Oral; D000328:Adult; D000726:Androgen Antagonists / Q000008:administration & dosage; D017373:Cyproterone Acetate / Q000009:adverse effects; D004219:District of Columbia / Q000453:epidemiology; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects*; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects*; D005060:Europe; D005260:Female; D005783:Gender Identity; D012739:Gonadal Steroid Hormones / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013148:Spironolactone / Q000008:administration & dosage / Q000009:adverse effects; D063106:Transgender Persons / Q000523:psychology; D014189:Transsexualism / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000453:epidemiology
D000726:Androgen Antagonists; D004967:Estrogens; D012739:Gonadal Steroid Hormones; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D017373:Cyproterone Acetate; D004958:Estradiol
Cross-Sex Hormone Therapy; Gender Identity; Hormone Replacement Therapy; Transgender Persons; Venous Thromboembolism