The following is a summary of “Evaluating the risk of venous thromboembolism in transfeminine and gender diverse people: A retrospective analysis.,” published in the September 2024 issue of Endocrinology by Slack et al.

The potential risk of venous thromboembolism (VTE) associated with feminizing gender-affirming hormone therapy (GAHT) remains a critical concern within the transgender and gender-diverse (TGD) population. This study aimed to evaluate the association between GAHT and other potential risk factors with the incidence of VTE in TGD individuals. Researchers conducted a retrospective chart review of 2,126 TGD adults receiving care within a large urban health system, focusing on the prevalence of VTE and calculating odds ratios to determine the relationship between VTE and variables, including type of insurance provider, estrogen usage, and selected comorbid conditions. 

The analysis revealed that 0.8% of the cohort had a documented history of VTE. Individuals with a history of VTE were significantly older (p<0.001), more likely to self-identify as Hispanic or Black compared to white or Asian individuals (p<0.05), and more likely to be covered by Medicaid or Medicare rather than private insurance (p<0.01). Additionally, the prevalence of hyperlipidemia (p<0.001), diabetes mellitus (p<0.05), and hypercoagulable conditions (p<0.001) was markedly higher in the VTE-positive group. In univariate analyses, hyperlipidemia, diabetes mellitus, and type of insurer were significantly associated with increased odds of VTE. However, after adjusting for confounding factors such as age, race, and the number of comorbidities through multivariate analysis, none of the exposure variables, including estrogen use, remained significantly associated with VTE risk. 

These findings suggest that the prevalence of VTE in the TGD cohort was lower than previously reported in other studies and that no single risk factor, including estrogen therapy, independently increased VTE risk when accounting for demographic and comorbid variables. This indicates that factors such as advanced age and the presence of multiple cardiometabolic comorbidities may be more critical in determining VTE risk among TGD individuals. Consequently, those who are older and have multiple cardiometabolic conditions may benefit from enhanced clinical surveillance and targeted strategies to mitigate modifiable risk factors for VTE. Overall, this study contributes valuable insights into the safety profile of GAHT in TGD populations and underscores the importance of individualized risk assessment in clinical practice to optimize patient outcomes and ensure the safe administration of hormone therapies.

Source: sciencedirect.com/science/article/abs/pii/S1530891X24006633